Healthcare Provider Details

I. General information

NPI: 1093910770
Provider Name (Legal Business Name): VIGEN ALIKHANIAN DDS. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3927 W BURBANK BLVD
BURBANK CA
91505
US

IV. Provider business mailing address

3927 W BURBANK BLVD
BURBANK CA
91505
US

V. Phone/Fax

Practice location:
  • Phone: 818-845-0900
  • Fax: 818-845-0980
Mailing address:
  • Phone: 818-845-0900
  • Fax: 818-845-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number54443
License Number StateCA

VIII. Authorized Official

Name: VIGEN ALIKHANIAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-845-0900