Individual
AMBARTSUM MAYTESYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18528 GAULT ST, RESEDA, CA 91335-4202
(818) 776-0055
Mailing address
18528 GAULT ST, RESEDA, CA 91335-4202
(818) 776-0055
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
49595
CA
Other
Enumeration date
12/14/2006
Last updated
07/08/2007
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