Healthcare Provider Details

I. General information

NPI: 1053056283
Provider Name (Legal Business Name): DEENA HOVSEPIAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71949 HIGHWAY 111 STE 100B
RANCHO MIRAGE CA
92270-4826
US

IV. Provider business mailing address

12740 N WATT LN UNIT E
SYLMAR CA
91342-4889
US

V. Phone/Fax

Practice location:
  • Phone: 760-565-6055
  • Fax:
Mailing address:
  • Phone: 818-445-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number107759
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: