Provider Demographics
NPI:1134682214
Name:BEHROUZIAN, MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BEHROUZIAN
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 1:29 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4232
Mailing Address - Country:US
Mailing Address - Phone:818-640-1037
Mailing Address - Fax:212-633-6961
Practice Address - Street 1:29 W 19TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4232
Practice Address - Country:US
Practice Address - Phone:212-675-7877
Practice Address - Fax:212-633-6961
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-07
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist