=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558840116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARLEN VARTANIAN, D.D.S, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2018
-----------------------------------------------------
Last Update Date | 08/14/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E HUNTINGTON DR STE 211
-----------------------------------------------------
City | ALHAMBRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91801-1022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-282-4195
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2015 FAIRMONT DR
-----------------------------------------------------
City | SAN MATEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94402-3925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-270-8990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ARLEN VARTANIAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 650-270-8990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 62865
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------