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General NPI Number Information
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NPI Number | 1689847493
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Entity Type | Organization
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Legal Business Name | KHODAVERDIAN,KHACHATOORIAN,DDS,INC
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Dates
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Enumeration Date | 04/12/2008
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Last Update Date | 04/12/2008
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Provider Practice Location Address
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Address Line | 428 ARDEN AVE SUITE 100
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City | GLENDALE
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State | CA
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Zip | 91203-1108
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Country | US
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Telephone | 818-547-4020
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Fax | 818-547-4020
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Provider Business Mailing Address
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Address Line | 428 ARDEN AVE SUITE 100
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City | GLENDALE
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State | CA
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Zip | 91203-1108
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Country | US
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Telephone | 818-547-4020
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Fax | 818-547-4026
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NJDIK KHODAVERDIAN
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Credential | DDS
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Telephone | 818-547-4020
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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 | 49345
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License Number State | CA
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