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General NPI Number Information
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NPI Number | 1790505907
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Entity Type | Organization
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Legal Business Name | EMPOWER DENTAL RANCHO-ARKELAKYAN DENTAL GROUP, INC
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 9275 BASE LINE RD
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1203
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Country | US
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Telephone | 909-490-5576
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 N HOLLYWOOD WAY UNIT 101
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City | BURBANK
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State | CA
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Zip | 91505-2149
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Country | US
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Telephone | 818-601-8550
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Fax |
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Authorized Official
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Title or Position | SECRETART
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Name | MR. KAREN KEVIN KHACHATRYAN
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Credential | DDS
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Telephone | 818-601-8550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 125K00000X
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Taxonomy Name | Advanced Practice Dental Therapist
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License Number |
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License Number State |
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