Provider Demographics
NPI:1225927247
Name:ANDRE MARDEROSIAN DMD INC
Entity type:Organization
Organization Name:ANDRE MARDEROSIAN DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARDEROSIAN DMD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-239-2217
Mailing Address - Street 1:1134 N BRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2504
Mailing Address - Country:US
Mailing Address - Phone:818-246-2253
Mailing Address - Fax:
Practice Address - Street 1:1134 N BRAND BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2504
Practice Address - Country:US
Practice Address - Phone:818-246-2253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental