Provider Demographics
NPI:1538601745
Name:ANANYAN, LIANA (DMD)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:ANANYAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LIANA
Other - Middle Name:
Other - Last Name:ANANYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:620 E PALM AVE
Mailing Address - Street 2:302
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2865
Mailing Address - Country:US
Mailing Address - Phone:704-246-9194
Mailing Address - Fax:
Practice Address - Street 1:212 N GLENDALE AVE
Practice Address - Street 2:100
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4734
Practice Address - Country:US
Practice Address - Phone:704-246-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100808122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist