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NPI Code Detail

MEDICARE: B. DEIRMENJIAN, DDS, INC

MEDICARE: B. DEIRMENJIAN, 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 Dentistry40804CA

General Provider Information

NPI Number : 1528544814
Entity Type Code : Organization
Provider Name (Legal Business Name) : B. DEIRMENJIAN, DDS, INC
Provider Business Mailing Address
First Line : 12640 HESPERIA RD STE A
Second Line :
City : VICTORVILLE
State : CA
Zip : 92395-7753
Country : US
Telephone Number : 760-241-3336
Fax Number :
Provider Business Practice Location Address
First Line : 1440 W MANCHESTER AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90047-5422
Country : US
Telephone Number : 323-753-1141
Fax Number :
Authorized Official
Title or Position : OWNER/CEO
Name : BAROUIR ARSHAG DEIRMENJIAN
Credential :
Telephone Number : 310-497-2211
Provider Enumeration Date : 07/19/2018
Last Update Date : 08/31/2021

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