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General NPI Number Information
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NPI Number | 1518292374
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Entity Type | Organization
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Legal Business Name | ALEN BAKHTAMIAN PROFESSIONAL DENTAL CORPORATION FAIR OAKS SPECIALTY
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 10059 LAUREL CANYON BLVD STE #A
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City | PACOIMA
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State | CA
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Zip | 91331-3847
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Country | US
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Telephone | 818-896-0043
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Fax | 818-896-0054
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Provider Business Mailing Address
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Address Line | 10059 LAUREL CANYON BLVD STE #A
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City | PACOIMA
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State | CA
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Zip | 91331-3847
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Country | US
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Telephone | 818-896-0043
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Fax | 818-896-0054
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Authorized Official
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Title or Position | ASSISTANT MANAGER
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Name | AURORA GIL
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Credential |
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Telephone | 818-896-0043
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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 | 39753
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License Number State | CA
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