Healthcare Provider Details

I. General information

NPI: 1699659870
Provider Name (Legal Business Name): CHRISTINA OHANESIAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 W FOOTHILL BLVD
UPLAND CA
91786-3727
US

IV. Provider business mailing address

2172 BASELINE RD
LA VERNE CA
91750
US

V. Phone/Fax

Practice location:
  • Phone: 909-657-1089
  • Fax:
Mailing address:
  • Phone: 909-938-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number111783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: