Provider Demographics
NPI:1073501417
Name:PAPAZIAN, KRIKOR
Entity Type:Individual
Prefix:
First Name:KRIKOR
Middle Name:
Last Name:PAPAZIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 WAUKEGAN RD
Mailing Address - Street 2:SUIT 110
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2126
Mailing Address - Country:US
Mailing Address - Phone:847-967-0400
Mailing Address - Fax:847-967-0760
Practice Address - Street 1:8930 WAUKEGAN RD
Practice Address - Street 2:SUIT 110
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2126
Practice Address - Country:US
Practice Address - Phone:847-967-0400
Practice Address - Fax:847-967-0760
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1005479Medicaid