Healthcare Provider Details

I. General information

NPI: 1780578799
Provider Name (Legal Business Name): LILIT BAGDASARIAN DDS A PROFETIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 HOLLYWOOD BLVD STE 200
LOS ANGELES CA
90027-6135
US

IV. Provider business mailing address

5106 HOLLYWOOD BLVD
LOS ANGELES CA
90027-6115
US

V. Phone/Fax

Practice location:
  • Phone: 323-667-9127
  • Fax:
Mailing address:
  • Phone: 323-667-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LILIT BAGDASARIAN
Title or Position: CEO
Credential: DDS
Phone: 818-445-4286