Provider Demographics
NPI:1356560494
Name:B. DEIRMENJIAN, DDS, INC.
Entity type:Organization
Organization Name:B. DEIRMENJIAN, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BAROUIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIRMENJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-923-6981
Mailing Address - Street 1:260 S GLENDORA AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3041
Mailing Address - Country:US
Mailing Address - Phone:626-214-1900
Mailing Address - Fax:626-214-1954
Practice Address - Street 1:3150 E IMPERIAL HWY STE 200
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3226
Practice Address - Country:US
Practice Address - Phone:310-608-7777
Practice Address - Fax:310-608-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty