Healthcare Provider Details

I. General information

NPI: 1578372017
Provider Name (Legal Business Name): B. DEIRMENJIAN, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 W MANCHESTER AVE
LOS ANGELES CA
90047-5422
US

IV. Provider business mailing address

15500 W SAND ST STE 6
VICTORVILLE CA
92392-2931
US

V. Phone/Fax

Practice location:
  • Phone: 323-753-1141
  • Fax:
Mailing address:
  • Phone: 760-205-8852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BAROUIR ARSHAG DEIRMENJIAN
Title or Position: OWNER/CEO
Credential:
Phone: 310-497-2211