Healthcare Provider Details

I. General information

NPI: 1821166075
Provider Name (Legal Business Name): ARSEN OGANESYAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11516 OXNARD ST
N HOLLYWOOD CA
91606-4810
US

IV. Provider business mailing address

11516 OXNARD ST
NORTH HOLLYWOOD CA
91606-4810
US

V. Phone/Fax

Practice location:
  • Phone: 818-769-9551
  • Fax: 818-769-2131
Mailing address:
  • Phone: 818-769-9551
  • Fax: 818-769-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberB41766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: