Healthcare Provider Details

I. General information

NPI: 1689861676
Provider Name (Legal Business Name): KEKLIKIAN GRIGORIAN DENTAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 LAS POSAS RD STE 6
CAMARILLO CA
93010-1502
US

IV. Provider business mailing address

3901 LAS POSAS RD STE 6
CAMARILLO CA
93010-1502
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-0555
  • Fax: 805-484-0553
Mailing address:
  • Phone: 805-484-0555
  • Fax: 805-484-0553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. VATCHE KEKLIKIAN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 805-484-0555