Healthcare Provider Details

I. General information

NPI: 1861822702
Provider Name (Legal Business Name): MEHRABIAN & AMBARACHYAN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15071 IMPERIAL HWY
LA MIRADA CA
90638-1302
US

IV. Provider business mailing address

15071 IMPERIAL HWY
LA MIRADA CA
90638-1302
US

V. Phone/Fax

Practice location:
  • Phone: 818-903-3789
  • Fax:
Mailing address:
  • Phone: 818-903-3789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number51039
License Number StateCA

VIII. Authorized Official

Name: DR. ARMEN AMBARCHYAN
Title or Position: PRESIDENT
Credential:
Phone: 818-903-3789