Provider Demographics
NPI:1902237845
Name:MEHRABIAN & AMBARACHYAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:MEHRABIAN & AMBARACHYAN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VAHAG
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-667-1151
Mailing Address - Street 1:15071 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1302
Mailing Address - Country:US
Mailing Address - Phone:562-947-7000
Mailing Address - Fax:
Practice Address - Street 1:15071 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1302
Practice Address - Country:US
Practice Address - Phone:562-947-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty