Provider Demographics
NPI:1487837803
Name:DERHARTOUNIAN, HARMIK (DDS)
Entity type:Individual
Prefix:DR
First Name:HARMIK
Middle Name:
Last Name:DERHARTOUNIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S. GARFILED AVE # 101
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640
Mailing Address - Country:US
Mailing Address - Phone:323-725-6797
Mailing Address - Fax:323-725-7692
Practice Address - Street 1:111 S GARFIELD AVE STE 101
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3806
Practice Address - Country:US
Practice Address - Phone:323-725-6797
Practice Address - Fax:323-725-7692
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB-41394-01OtherDENITCAL
CAB41394-02OtherDENTICAL