Provider Demographics
NPI:1053516518
Name:HARMANDARIAN, ANNA (DDS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:HARMANDARIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041
Mailing Address - Country:US
Mailing Address - Phone:323-474-6212
Mailing Address - Fax:323-474-6287
Practice Address - Street 1:1609 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1402
Practice Address - Country:US
Practice Address - Phone:323-474-6212
Practice Address - Fax:323-474-6212
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice