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General NPI Number Information
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NPI Number | 1316391071
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Entity Type | Organization
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Legal Business Name | DR. OHANNESSIAN DENTAL CORP
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 6350 W RAMSEY ST STE. A
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City | BANNING
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State | CA
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Zip | 92220-3062
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Country | US
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Telephone | 951-769-0466
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 618
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City | HIGHLAND
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State | CA
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Zip | 92346-0618
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Country | US
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Telephone | 951-769-0466
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Fax |
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Authorized Official
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Title or Position | CEO/DDS
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Name | MANUEL JEAN OHANNESSIAN
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Credential |
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Telephone | 951-769-0466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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