Healthcare Provider Details

I. General information

NPI: 1477094035
Provider Name (Legal Business Name): ARGINA KUDAVERDIAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18740 VENTURA BLVD STE 108
TARZANA CA
91356-6303
US

IV. Provider business mailing address

18740 VENTURA BLVD STE 108
TARZANA CA
91356-6303
US

V. Phone/Fax

Practice location:
  • Phone: 818-776-1236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number103032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: