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General NPI Number Information
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NPI Number | 1922418599
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Entity Type | Organization
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Legal Business Name | SPARTAK DELAKYAN D.D.S., INC.
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 2332 W WHITTIER BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-3039
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Country | US
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Telephone | 323-728-3292
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Fax | 323-728-6329
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Provider Business Mailing Address
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Address Line | 1214 1/2 S GREENWOOD AVE
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City | MONTEBELLO
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State | CA
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Zip | 90640-6329
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Country | US
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Telephone | 323-728-3292
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Fax | 323-728-6329
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SPARTAK DELAKYAN
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Credential | D.D.S
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Telephone | 818-523-3005
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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 | 61368
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License Number State | CA
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