Healthcare Provider Details

I. General information

NPI: 1396868774
Provider Name (Legal Business Name): ARMOND KOTIKIAN M.D., DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 N. GLENDALE AVE
GLENDALE CA
91206
US

IV. Provider business mailing address

242 N GLENDALE AVE
GLENDALE CA
91206-4454
US

V. Phone/Fax

Practice location:
  • Phone: 818-484-8939
  • Fax:
Mailing address:
  • Phone: 818-484-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number49568
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number106145
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301086538
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: