| Grigoryan Professional Dental Corp | |
|
485 E Foothill Blvd E Upland CA 91786-3987 | |
| (909) 291-8625 | |
| (909) 291-8629 |
| Full Name | Grigoryan Professional Dental Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 485 E Foothill Blvd, Upland, California |
| Authorized Official Name and Position | Vahan Grigoryan (OWNER/DENTIST) |
| Authorized Official Contact | 9092918625 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grigoryan Professional Dental Corp 485 E Foothill Blvd E Upland CA 91786-3987 Ph: (909) 291-8625 | Grigoryan Professional Dental Corp 485 E Foothill Blvd E Upland CA 91786-3987 Ph: (909) 291-8625 |
| NPI Number | 1932534450 |
|---|---|
| Provider Enumeration Date | 09/04/2013 |
| Last Update Date | 09/04/2013 |
| Medicare PECOS PAC ID | 5991063307 |
|---|---|
| Medicare Enrollment ID | O20180118002001 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932534450 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Vahan Grigoryan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1235211541 PECOS PAC ID: 2163723941 Enrollment ID: I20171227000972 |
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