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General NPI Number Information
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NPI Number | 1205999091
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Entity Type | Individual
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Provider Name | ARMEN MARDIROSSIAN DDS MS
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 13197 CENTRAL AVE SUITE 201
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-613-1366
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Fax | 909-613-1477
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Provider Business Mailing Address
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Address Line | 13197 CENTRAL AVE STE 201
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City | CHINO
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State | CA
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Zip | 91710-4178
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Country | US
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Telephone | 909-613-1366
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Fax | 909-613-1477
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 45919
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License Number State | CA
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