Provider Demographics
NPI:1124556451
Name:GAZARIAN, HAIG LEVON (DMD, MA)
Entity Type:Individual
Prefix:DR
First Name:HAIG
Middle Name:LEVON
Last Name:GAZARIAN
Suffix:
Gender:M
Credentials:DMD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2640
Mailing Address - Country:US
Mailing Address - Phone:626-590-3511
Mailing Address - Fax:
Practice Address - Street 1:925 W FOOTHILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-6603
Practice Address - Country:US
Practice Address - Phone:626-873-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1018511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice