Provider Demographics
NPI:1023204039
Name:MISSIRLIAN, HARUTUN ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARUTUN
Middle Name:ARTHUR
Last Name:MISSIRLIAN
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 1:2 E POINTE CT
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-1392
Mailing Address - Country:US
Mailing Address - Phone:334-347-3061
Mailing Address - Fax:334-347-1101
Practice Address - Street 1:2 E POINTE CT
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-1392
Practice Address - Country:US
Practice Address - Phone:334-347-3061
Practice Address - Fax:334-347-1101
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7595122300000X
AL6161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist