Healthcare Provider Details

I. General information

NPI: 1851948061
Provider Name (Legal Business Name): HAMLET KHACHATRYAN DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 CRUICKSHANK DRIVE SUITE B
EL CENTRO CA
92243
US

IV. Provider business mailing address

2022 ROSITA AVE
BURBANK CA
91504-2821
US

V. Phone/Fax

Practice location:
  • Phone: 760-970-8754
  • Fax:
Mailing address:
  • Phone: 818-300-5849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HAMLET KHACHATRYAN
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 818-300-5849