Healthcare Provider Details

I. General information

NPI: 1396944989
Provider Name (Legal Business Name): VRAM J. KARGODORIAN D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18250 ROSCOE BLVD 355
NORTHRIDGE CA
91325-4226
US

IV. Provider business mailing address

18250 ROSCOE BLVD 355
NORTHRIDGE CA
91325
US

V. Phone/Fax

Practice location:
  • Phone: 818-701-5311
  • Fax:
Mailing address:
  • Phone: 818-701-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number39820
License Number StateCA

VIII. Authorized Official

Name: DR. VRAM J KARGODORIAN
Title or Position: DENTIST
Credential: D.D.S.
Phone: 818-701-5311