Provider Demographics
NPI:1538585328
Name:SERGEY TATULYAN DDS, INC.
Entity type:Organization
Organization Name:SERGEY TATULYAN DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TATULYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-885-7116
Mailing Address - Street 1:18856 ROSCOE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-6302
Mailing Address - Country:US
Mailing Address - Phone:818-885-7116
Mailing Address - Fax:818-885-1904
Practice Address - Street 1:18856 ROSCOE BLVD STE A
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-6302
Practice Address - Country:US
Practice Address - Phone:818-885-7116
Practice Address - Fax:818-885-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental