Healthcare Provider Details

I. General information

NPI: 1720140627
Provider Name (Legal Business Name): YERVANT G ASLANIAN DDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 E GLENOAKS BLVD #204
GLENDALE CA
91207-2035
US

IV. Provider business mailing address

418 E GLENOAKS BLVD #204
GLENDALE CA
91207-2035
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 Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number39130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: