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NPI Code Detail

MEDICARE: B. DEIRMENJIAN, D.D.S., INC.

MEDICARE: B. DEIRMENJIAN, D.D.S., 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
1122300000XDentist
21223G0001XGeneral Practice Dentistry
31223X0400XOrthodontics and Dentofacial Orthopedics Dentistry
41223P0221XPediatric Dentistry

General Provider Information

NPI Number : 1376365098
Entity Type Code : Organization
Provider Name (Legal Business Name) : B. DEIRMENJIAN, D.D.S., INC.
Provider Business Mailing Address
First Line : 15500 W SAND ST STE 6
Second Line :
City : VICTORVILLE
State : CA
Zip : 92392-2931
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1450 W MANCHESTER AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90047-5422
Country : US
Telephone Number : 760-241-3336
Fax Number :
Authorized Official
Title or Position : OWNER/CEO
Name : BAROUIR ARSHAG DEIRMENJIAN
Credential :
Telephone Number : 310-497-2211
Provider Enumeration Date : 10/25/2024
Last Update Date : 11/24/2025

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