Individual
DZHONI AVETISYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
16219 KEELER DR, GRANADA HILLS, CA 91344-3033
(818) 726-8160
Mailing address
16219 KEELER DR, GRANADA HILLS, CA 91344-3033
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
64697
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64697
DENTAL BOARD OF CALIFORNIA
CA
Enumeration date
12/02/2015
Last updated
12/02/2015
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