Healthcare Provider Details

I. General information

NPI: 1164572053
Provider Name (Legal Business Name): HOVSEP NARGIZYAN, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 N MOUNT VERNON AVE UNIT B
SAN BERNARDINO CA
92411-1427
US

IV. Provider business mailing address

1655 N MOUNT VERNON AVE UNIT B
SAN BERNARDINO CA
92411-1427
US

V. Phone/Fax

Practice location:
  • Phone: 909-885-8707
  • Fax: 909-885-9447
Mailing address:
  • Phone: 909-885-8707
  • Fax: 909-885-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number51112
License Number StateCA

VIII. Authorized Official

Name: DR. HOVSEP NARGIZYAN
Title or Position: OWNER
Credential: DDS
Phone: 909-885-8707