Healthcare Provider Details

I. General information

NPI: 1083498372
Provider Name (Legal Business Name): JOHN OGANESYAN DDS., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 WILSHIRE BLVD STE 903
LOS ANGELES CA
90017-3910
US

IV. Provider business mailing address

1127 WILSHIRE BLVD STE 903
LOS ANGELES CA
90017-3910
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-1155
  • Fax: 213-481-1156
Mailing address:
  • Phone: 213-481-1155
  • Fax: 213-481-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN OGANESYAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-200-3491