=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366181711
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARGINA KUDAVERDIAN DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2022
-----------------------------------------------------
Last Update Date | 04/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18740 VENTURA BLVD STE 108
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-6303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-776-1236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18740 VENTURA BLVD STE 108
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-6303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-776-1236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ARGINA KUDAVERDIAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 818-317-7018
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------