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General NPI Number Information
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NPI Number | 1497268700
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Entity Type | Organization
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Legal Business Name | DEIRMENJIAN DENTAL GROUP INC
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 12640 HESPERIA RD STE C
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City | VICTORVILLE
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State | CA
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Zip | 92395-7753
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Country | US
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Telephone | 760-241-3336
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Fax | 760-243-7247
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Provider Business Mailing Address
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Address Line | 12640 HESPERIA RD STE C
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City | VICTORVILLE
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State | CA
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Zip | 92395-7753
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Country | US
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Telephone | 760-241-3336
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Fax | 760-243-7247
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | BAROUIR DEIRMENJIAN
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Credential | DDS
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Telephone | 760-241-3336
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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 | 40804
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License Number State | CA
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