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General NPI Number Information
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NPI Number | 1285454132
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Entity Type | Organization
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Legal Business Name | UTUDJIAN DDS INC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 2244 FAIR PARK AVE
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City | LOS ANGELES
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State | CA
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Zip | 90041-1910
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Country | US
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Telephone | 818-434-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 1921 N BUENA VISTA ST UNIT 415
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City | BURBANK
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State | CA
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Zip | 91504-3385
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Country | US
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Telephone | 818-434-6060
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GAREN UTUDJIAN
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Credential | DDS
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Telephone | 818-434-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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