Ambartsum Maytesyan

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

49595 Issued in CA

Practice address

18528 Gault St
Reseda, CA 91335-4202

Phone

(818) 776-0055

NPI assigned

Dec 14, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mddds Group Inc

  • General Practice Dentistry
  • Reseda, CA
  • NPI 1134956717
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972665172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18528 GAULT ST",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913354202",
            "telephone_number": "818-776-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18528 GAULT ST",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913354202",
            "telephone_number": "818-776-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYTESYAN",
        "first_name": "AMBARTSUM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "49595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matian DDS Inc
• Kamal Matian, D.D.S
• Shawn Matian, D.D.S.
• Lauren Kieva Matsuno
• Eric Anothony Mattern
• Mary McCabe
• Nicole Esther McCarthy, LCSW
• Christine Anne McCrory, M.C.D., SLP-CF
• Sherika McGhee, ACSW
• Kelly McKendree, COTA

• General Practice Dentistry in Reseda, CA
• Providers in Reseda, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.