Provider Demographics
NPI:1538821236
Name:POGHOSIAN, LAURA (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:POGHOSIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:POGOSIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:12420 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1617
Mailing Address - Country:US
Mailing Address - Phone:818-434-4818
Mailing Address - Fax:
Practice Address - Street 1:12420 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-1617
Practice Address - Country:US
Practice Address - Phone:818-509-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist