Provider Demographics
NPI:1104828680
Name:GHAZARIAN, KRIKOR P (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRIKOR
Middle Name:P
Last Name:GHAZARIAN
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 1:5635 STONESTHROW DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7442
Mailing Address - Country:US
Mailing Address - Phone:330-264-9678
Mailing Address - Fax:
Practice Address - Street 1:130 S MARKET ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4839
Practice Address - Country:US
Practice Address - Phone:330-264-9678
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH176561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0560325Medicaid
OH2480257Medicaid