Healthcare Provider Details

I. General information

NPI: 1760624977
Provider Name (Legal Business Name): YERVANT G ASLANIAN, DDS, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 E GLENOAKS BLVD #204
GLENDALE CA
91207-4283
US

IV. Provider business mailing address

418 E GLENOAKS BLVD #204
GLENDALE CA
91207-4283
US

V. Phone/Fax

Practice location:
  • Phone: 818-247-3317
  • Fax: 818-247-0635
Mailing address:
  • Phone: 818-247-3317
  • Fax: 818-247-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number39130
License Number StateCA

VIII. Authorized Official

Name: DIANA BILEMDJIAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-247-3317