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General NPI Number Information
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NPI Number | 1649443516
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Entity Type | Organization
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Legal Business Name | MARIYA GRIGORYAN DDS INC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 2634 W WALNUT AVE
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City | VISALIA
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State | CA
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Zip | 93277-4378
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Country | US
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Telephone | 559-732-7224
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Fax | 559-732-7226
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Provider Business Mailing Address
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Address Line | 2634 W WALNUT AVE
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City | VISALIA
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State | CA
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Zip | 93277-4378
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Country | US
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Telephone | 559-732-7224
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Fax | 559-732-7226
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARIYA GRIGORYAN
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Credential | DMD
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Telephone | 559-732-7224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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