Healthcare Provider Details

I. General information

NPI: 1770107252
Provider Name (Legal Business Name): GARABEDIAN DENTAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 RUBERTA AVE APT 1
GLENDALE CA
91201-2195
US

IV. Provider business mailing address

1055 RUBERTA AVE APT 1
GLENDALE CA
91201-2195
US

V. Phone/Fax

Practice location:
  • Phone: 949-317-3197
  • Fax: 949-317-3197
Mailing address:
  • Phone: 949-317-3197
  • Fax: 949-317-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: RAFFIE GARABEDIAN
Title or Position: DDS/OWNER
Credential: DDS
Phone: 949-317-3197