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NPI Code Detail

MEDICARE: HOVSEP NARGIZYAN, DDS, INC.

MEDICARE: HOVSEP NARGIZYAN, DDS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry51112CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1161-9568OTHERCAUNITED CONCORDIA
2G94087-01OTHERCADENTI-CAL

General Provider Information

NPI Number : 1164572053
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOVSEP NARGIZYAN, DDS, INC.
Provider Business Mailing Address
First Line : 1655 N MOUNT VERNON AVE
Second Line : UNIT B
City : SAN BERNARDINO
State : CA
Zip : 92411-1427
Country : US
Telephone Number : 909-885-8707
Fax Number : 909-885-9447
Provider Business Practice Location Address
First Line : 1655 N MOUNT VERNON AVE
Second Line : UNIT B
City : SAN BERNARDINO
State : CA
Zip : 92411-1427
Country : US
Telephone Number : 909-885-8707
Fax Number : 909-885-9447
Authorized Official
Title or Position : OWNER
Name : DR. HOVSEP NARGIZYAN
Credential : DDS
Telephone Number : 909-885-8707
Provider Enumeration Date : 01/11/2007
Last Update Date : 05/17/2024

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