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General NPI Number Information
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NPI Number | 1538585328
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Entity Type | Organization
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Legal Business Name | SERGEY TATULYAN DDS, INC.
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 18856 ROSCOE BLVD STE A
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City | NORTHRIDGE
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State | CA
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Zip | 91324-6302
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Country | US
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Telephone | 818-885-7116
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Fax | 818-885-1904
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Provider Business Mailing Address
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Address Line | 18856 ROSCOE BLVD STE A
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City | NORTHRIDGE
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State | CA
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Zip | 91324-6302
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Country | US
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Telephone | 818-885-7116
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Fax | 818-885-1904
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Authorized Official
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Title or Position | PRESIDENT
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Name | SERGEY TATULYAN
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Credential |
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Telephone | 818-885-7116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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