=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215425293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARAM GRIGORYAN DDS DENTAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2018
-----------------------------------------------------
Last Update Date | 04/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9146 SEPULVEDA BLVD STE A
-----------------------------------------------------
City | NORTH HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91343-6948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-830-7000
-----------------------------------------------------
Fax | 818-830-7013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9146 SEPULVEDA BLVD STE A
-----------------------------------------------------
City | NORTH HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91343-6948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-830-7000
-----------------------------------------------------
Fax | 818-830-7013
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ARAM GRIGORYAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 818-424-5505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 64956
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------