Healthcare Provider Details

I. General information

NPI: 1912452251
Provider Name (Legal Business Name): NIGOGHOSIAN & NIGOGHOSIAN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 W FOOTHILL BLVD
UPLAND CA
91786-3731
US

IV. Provider business mailing address

1049 W FOOTHILL BLVD
UPLAND CA
91786-3731
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-1966
  • Fax: 909-982-1550
Mailing address:
  • Phone: 909-985-1966
  • Fax: 909-982-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHNNY NIGOGHOSIAN
Title or Position: OWNER
Credential: DDS
Phone: 909-985-1966