Healthcare Provider Details

I. General information

NPI: 1265988638
Provider Name (Legal Business Name): JOHN OGANESYAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
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:
Mailing address:
  • Phone: 213-481-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDDS100636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: