# RITA T. DERAGOBIAN DDS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295227288
- **Authorized official:** DR. RITA DERAGOBIAN DDS (DENTIST/OWNER)
- **Authorized official phone:** (626) 914-3900

## Contact information

- **Practice address:** 1435 E ROUTE 66 STE D, GLENDORA, CA 91740-3748
- **Practice address phone:** (626) 914-3900
- **Practice address fax:** (626) 914-0019
- **Mailing address:** 1435 E ROUTE 66 STE D, GLENDORA, CA 91740-3748
- **Mailing address phone:** (626) 914-3900
- **Mailing address fax:** (626) 914-0019

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 261QD0000X | Dental Clinic/Center | 55480 | CA | — |

## Other

- **Enumeration date:** 06/05/2018
- **Last updated:** 01/08/2020