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General NPI Number Information
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NPI Number | 1003041302
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Entity Type | Individual
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Provider Name | ARTIN MANOUKIAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2009
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 2307 FLORENCITA AVE
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City | MONTROSE
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State | CA
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Zip | 91020-1817
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Country | US
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Telephone | 818-249-1146
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Fax | 818-249-9612
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Provider Business Mailing Address
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Address Line | PO BOX 3151
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City | GLENDALE
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State | CA
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Zip | 91221-0151
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Country | US
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Telephone | 818-795-0967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 54750
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License Number State | CA
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