Provider Demographics
NPI:1902578206
Name:MKRTYCHYAN, IREN (DDS)
Entity Type:Individual
Prefix:
First Name:IREN
Middle Name:
Last Name:MKRTYCHYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7297 SITIO LIRIO
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-9529
Mailing Address - Country:US
Mailing Address - Phone:760-828-5875
Mailing Address - Fax:
Practice Address - Street 1:3268 GREYLING DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2230
Practice Address - Country:US
Practice Address - Phone:858-617-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist