Healthcare Provider Details

I. General information

NPI: 1194940874
Provider Name (Legal Business Name): ARMEN KUPELIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PAGE ST
COTATI CA
94931-4314
US

IV. Provider business mailing address

7 PAGE ST
COTATI CA
94931-4314
US

V. Phone/Fax

Practice location:
  • Phone: 707-795-5419
  • Fax: 707-795-5925
Mailing address:
  • Phone: 707-795-5419
  • Fax: 707-795-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: