1750354098 NPI number — CARLOS DER BOGHOSSIAN DDS INC

Table of content: (NPI 1750354098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750354098 NPI number — CARLOS DER BOGHOSSIAN DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLOS DER BOGHOSSIAN DDS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ARLINGTON FAMILY DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750354098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6160 ARLINGTON AVE
Provider Second Line Business Mailing Address:
SUITE D4
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92504-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-637-0013
Provider Business Mailing Address Fax Number:
951-637-0016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6160 ARLINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE D4
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92504-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-637-0013
Provider Business Practice Location Address Fax Number:
951-637-0016
Provider Enumeration Date:
02/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DER BOGHOSSIAN
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
951-637-0013

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  38832 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)