Healthcare Provider Details

I. General information

NPI: 1851546493
Provider Name (Legal Business Name): VAHAN GRIGORYAN, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7993 SIERRA AVE SUITE D
FONTANA CA
92336-3330
US

IV. Provider business mailing address

7993 SIERRA AVE SUITE D
FONTANA CA
92336-3330
US

V. Phone/Fax

Practice location:
  • Phone: 909-428-5111
  • Fax: 909-428-5757
Mailing address:
  • Phone: 909-428-5111
  • Fax: 909-428-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number49536
License Number StateCA

VIII. Authorized Official

Name: DR. VAHAN GRIGORYAN
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 909-428-5111