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General NPI Number Information
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NPI Number | 1285838730
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Entity Type | Individual
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Provider Name | VAHE ANTANESIAN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 5819 ADENMOOR AVE
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City | LAKEWOOD
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State | CA
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Zip | 90713-1067
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Country | US
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Telephone | 805-570-0600
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Fax | 805-579-3792
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Provider Business Mailing Address
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Address Line | 4210 E LOS ANGELES AVE STE F
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City | SIMI VALLEY
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State | CA
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Zip | 93063-3300
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Country | US
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Telephone | 805-570-0600
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Fax | 805-579-3792
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 46236
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License Number State | CA
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