Healthcare Provider Details

I. General information

NPI: 1881080398
Provider Name (Legal Business Name): ODET NAJARIAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10724 RIVERSIDE DR
TOLUCA LAKE CA
91602-2313
US

IV. Provider business mailing address

10724 RIVERSIDE DR
TOLUCA LAKE CA
91602-2313
US

V. Phone/Fax

Practice location:
  • Phone: 818-769-1111
  • Fax: 818-769-1136
Mailing address:
  • Phone: 818-769-1111
  • Fax: 818-769-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number40284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: