Provider Demographics
NPI:1063023158
Name:LOVIK MIRZAEIAN DDS INC.,
Entity Type:Organization
Organization Name:LOVIK MIRZAEIAN DDS INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-299-2168
Mailing Address - Street 1:1592 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4028
Mailing Address - Country:US
Mailing Address - Phone:559-299-2168
Mailing Address - Fax:
Practice Address - Street 1:1592 SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4028
Practice Address - Country:US
Practice Address - Phone:559-299-2168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty