Healthcare Provider Details

I. General information

NPI: 1184925687
Provider Name (Legal Business Name): NEW LOOK DENTAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E GLENOAKS BLVD STE 106
GLENDALE CA
91207-2134
US

IV. Provider business mailing address

125 E GLENOAKS BLVD STE 103
GLENDALE CA
91207-2131
US

V. Phone/Fax

Practice location:
  • Phone: 818-334-3692
  • Fax: 818-484-5760
Mailing address:
  • Phone: 818-334-3692
  • Fax: 818-484-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number57157
License Number StateCA

VIII. Authorized Official

Name: MRS. LOUSINE VAHAGN KIRAKOSIAN
Title or Position: DENTIST /OWNER
Credential: D.D.S.
Phone: 818-334-3692