Healthcare Provider Details

I. General information

NPI: 1881082220
Provider Name (Legal Business Name): CAROLINE KHACHATOORIAN-SANTE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10655 RIVERSIDE DR
TOLUCA LAKE CA
91602-2341
US

IV. Provider business mailing address

10655 RIVERSIDE DR
TOLUCA LAKE CA
91602-2341
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 Number46192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: