Healthcare Provider Details

I. General information

NPI: 1679263206
Provider Name (Legal Business Name): DDS OF SHAHGALDIAN DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 VAN BUREN BLVD
RIVERSIDE CA
92503-2033
US

IV. Provider business mailing address

1526 EL RITO AVE
GLENDALE CA
91208-1931
US

V. Phone/Fax

Practice location:
  • Phone: 818-523-7626
  • Fax:
Mailing address:
  • Phone: 818-523-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINE SHAHGALDIAN
Title or Position: OWNER
Credential: DDS
Phone: 818-523-7626