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General NPI Number Information
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NPI Number | 1194943340
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Entity Type | Organization
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Legal Business Name | B. DEIRMENJIAN, DDS, INC.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 3150 E IMPERIAL HWY STE 210
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City | LYNWOOD
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State | CA
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Zip | 90262-3226
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Country | US
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Telephone | 310-667-4444
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Fax | 310-608-5444
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Provider Business Mailing Address
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Address Line | 260 S GLENDORA AVE 2ND FLOOR
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City | WEST COVINA
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State | CA
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Zip | 91790-3041
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Country | US
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Telephone | 626-214-1900
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Fax | 626-214-1954
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Authorized Official
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Title or Position | CEO
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Name | DR. BAROUIR DEIRMENJIAN
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Credential | DDS
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Telephone | 310-923-6981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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