Healthcare Provider Details

I. General information

NPI: 1649443516
Provider Name (Legal Business Name): MARIYA GRIGORYAN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2634 W WALNUT AVE
VISALIA CA
93277-4378
US

IV. Provider business mailing address

2634 W WALNUT AVE
VISALIA CA
93277-4378
US

V. Phone/Fax

Practice location:
  • Phone: 559-732-7224
  • Fax: 559-732-7226
Mailing address:
  • Phone: 559-732-7224
  • Fax: 559-732-7226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIYA GRIGORYAN
Title or Position: DENTIST
Credential: DMD
Phone: 559-732-7224