MEDICARE: BAROUIR DEIRMENJIAN DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223E0200X	Endodontics
3	1223P0221X	Pediatric Dentistry
4	1223P0300X	Periodontics
5	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
6	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1871192112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAROUIR DEIRMENJIAN DENTAL CORPORATION

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	:	3820 CONVOY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-3722
Country	:	US
Telephone Number	:	858-569-1100
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	BAROUIR ARSHAG DEIRMENJIAN
Credential	:
Telephone Number	:	310-497-2211

Provider Enumeration Date	:	10/19/2020
Last Update Date	:	03/02/2021

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