Asatryan & Bakhtamian Dental Corp
Organization Active NPI Oral and Maxillofacial Surgery Clinic/Center · La Crescenta, CA
NPI 1699345934 · NPPES record last updated Sep 29, 2021
Key facts
- NPI
- 1699345934
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Oral and Maxillofacial Surgery Clinic/Center 261QS0112X
- Legal business name
- ASATRYAN & BAKHTAMIAN DENTAL CORP
- Practice address
- 2644 Foothill Blvd
La Crescenta, CA 91214-3510 - Phone
- (818) 248-9988
- Fax
- (818) 248-0081
- NPI assigned
- Jun 29, 2021
- Organization subpart
- No
Authorized official
- Name
- Alen Bakhtamian
- Title
- Dentist
- Phone
- (818) 248-9988
Practitioners 1
-
Alen Bakhtamian, DMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211021001643 | CA | Part B Supplier - Clinic/Group Practice | 7618365784 |
Receives reassigned benefits from 1 practitioner Practice locations: La Crescenta, CA; Pasadena, CA; Pacoima, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | |||
| Oral and Maxillofacial Surgery Clinic/Center | 261QS0112X | Yes |
Addresses
Primary practice location
2644 Foothill Blvd
La Crescenta, CA 91214-3510
Mailing address
2644 Foothill Blvd
La Crescenta, CA 91214-3510
Phone (818) 248-9988
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All providers in La Crescenta, CA · Oral and Maxillofacial Surgery Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.