Healthcare Provider Details

I. General information

NPI: 1437083391
Provider Name (Legal Business Name): BOGOSIAN DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SANTA MONICA BLVD STE 305
LOS ANGELES CA
90025-6587
US

IV. Provider business mailing address

10700 SANTA MONICA BLVD STE 305
LOS ANGELES CA
90025-6587
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-7643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NINELLA BOGOSIAN
Title or Position: PRESIDENT
Credential:
Phone: 818-858-4406