=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790909836
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KARAPETYAN DENTAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1711 N GRAMERCY PL
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-460-6611
-----------------------------------------------------
Fax | 323-467-2225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1711 N GRAMERCY PL
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-460-6611
-----------------------------------------------------
Fax | 323-467-2225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ARMEN KARAPETYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-460-6611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | B4398501
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------