Healthcare Provider Details

I. General information

NPI: 1083191100
Provider Name (Legal Business Name): VAHE OHANESIAN DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2018
Last Update Date: 07/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 W HOSPITALITY LN
SAN BERNARDINO CA
92408-3348
US

IV. Provider business mailing address

1049 E HUNTINGTON DR UNIT C
MONROVIA CA
91016-3782
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4960
  • Fax:
Mailing address:
  • Phone: 818-434-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS100531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: