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12940 Foothill Blvd. C Sn Fernando CA 91340 | |
(818) 408-5100 | |
(818) 408-5111 |
Full Name | |
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Speciality | Dentist |
Location | 12940 Foothill Blvd., Sn Fernando, California |
Authorized Official Name and Position | Barouir Deirmenjian (CEO) |
Authorized Official Contact | 3109236981 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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260 S Glendora Ave 200 West Covina CA 91790-3041 Ph: (626) 214-1900 | 12940 Foothill Blvd. C Sn Fernando CA 91340 Ph: (818) 408-5100 |
NPI Number | 1992082960 |
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Provider Enumeration Date | 11/04/2011 |
Last Update Date | 11/04/2011 |
Identifier | Type | State | Issuer |
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1992082960 | NPI | - | NPPES |
1225097215 | Medicaid | CA |