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General NPI Number Information
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NPI Number | 1699068031
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Entity Type | Organization
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Legal Business Name | KRIKOR DERBABIAN, DDS, INC.
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 724 E CHAPEL ST
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City | SANTA MARIA
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State | CA
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Zip | 93454-4524
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Country | US
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Telephone | 805-928-0340
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Fax | 805-928-7580
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Provider Business Mailing Address
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Address Line | 724 E CHAPEL ST
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City | SANTA MARIA
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State | CA
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Zip | 93454-4524
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Country | US
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Telephone | 805-928-0340
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Fax | 805-928-7580
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KRIKOR DERBABIAN
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Credential | D.D.S.
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Telephone | 818-568-9054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 39145
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License Number State | CA
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