Healthcare Provider Details

I. General information

NPI: 1043146426
Provider Name (Legal Business Name): NARGIZYAN DDS APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
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: 909-361-3696
  • Fax:
Mailing address:
  • Phone: 909-361-3696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: HOVSEP NARGIZYAN
Title or Position: CEO
Credential: DDS
Phone: 909-361-3696