Provider Demographics
NPI:1548451008
Name:MASEREDJIAN, CHARLES JACOB JR (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JACOB
Last Name:MASEREDJIAN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4327
Mailing Address - Country:US
Mailing Address - Phone:818-841-4695
Mailing Address - Fax:818-841-5420
Practice Address - Street 1:3913 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4327
Practice Address - Country:US
Practice Address - Phone:818-841-4695
Practice Address - Fax:818-841-5420
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA188881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice