Provider Demographics
NPI:1861777062
Name:NISHAN W. MATOSSIAN, D.D.S
Entity type:Organization
Organization Name:NISHAN W. MATOSSIAN, D.D.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:JULIETTE
Authorized Official - Last Name:BOYADJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-888-2700
Mailing Address - Street 1:43845 10TH ST W STE 1A
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4800
Mailing Address - Country:US
Mailing Address - Phone:661-948-9646
Mailing Address - Fax:
Practice Address - Street 1:43845 10TH ST W STE 1A
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4800
Practice Address - Country:US
Practice Address - Phone:661-948-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37449305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization