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General NPI Number Information
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NPI Number | 1932534450
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Entity Type | Organization
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Legal Business Name | GRIGORYAN PROFESSIONAL DENTAL CORP
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 485 E FOOTHILL BLVD E
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City | UPLAND
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State | CA
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Zip | 91786-3987
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Country | US
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Telephone | 909-291-8625
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Fax | 909-291-8629
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Provider Business Mailing Address
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Address Line | 485 E FOOTHILL BLVD E
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City | UPLAND
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State | CA
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Zip | 91786-3987
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Country | US
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Telephone | 909-291-8625
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Fax | 909-291-8629
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | VAHAN GRIGORYAN
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Credential | D.D.S.
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Telephone | 909-291-8625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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