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General NPI Number Information
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NPI Number | 1770035677
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Entity Type | Organization
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Legal Business Name | DEIRMENJIAN DENTISTRY INC
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 470 W BADILLO ST
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City | COVINA
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State | CA
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Zip | 91723-1829
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Country | US
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Telephone | 626-331-8287
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Fax | 626-331-5795
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Provider Business Mailing Address
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Address Line | 15643 SHERMAN WAY SUITE 220
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City | VAN NUYS
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State | CA
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Zip | 91406-4135
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Country | US
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Telephone | 855-705-3434
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Fax | 855-705-3399
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Authorized Official
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Title or Position | OWNER
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Name | BAROUIR DEIRMENJIAN
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Credential | DDS
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Telephone | 855-705-3434
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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 | 40804
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License Number State | CA
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