1922418599 NPI number — SPARTAK DELAKYAN D.D.S., INC.

Table of content: (NPI 1922418599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922418599 NPI number — SPARTAK DELAKYAN D.D.S., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPARTAK DELAKYAN D.D.S., 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:
GREENWOOD 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:
1922418599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1214 1/2 S GREENWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEBELLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90640-6329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-728-3292
Provider Business Mailing Address Fax Number:
323-728-6329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2332 W WHITTIER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEBELLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90640-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-728-3292
Provider Business Practice Location Address Fax Number:
323-728-6329
Provider Enumeration Date:
05/05/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DELAKYAN
Authorized Official First Name:
SPARTAK
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
818-523-3005

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  61368 , 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)

  • Identifier: 1922418599 . This is a "GENERAL DENTIST" identifier . This identifiers is of the category "OTHER".