Healthcare Provider Details

I. General information

NPI: 1508466459
Provider Name (Legal Business Name): MARETTA ARSEN OGANESYAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11516 OXNARD ST
NORTH HOLLYWOOD CA
91606-4810
US

IV. Provider business mailing address

4239 WHISPERING PINES CT
ENCINO CA
91316-4459
US

V. Phone/Fax

Practice location:
  • Phone: 818-769-9551
  • Fax:
Mailing address:
  • Phone: 818-468-3019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number105660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: