Provider Demographics
NPI:1154827152
Name:ASSADOURIAN, MEGHRIK
Entity Type:Individual
Prefix:
First Name:MEGHRIK
Middle Name:
Last Name:ASSADOURIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7837 TURTLE COVE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6733
Mailing Address - Country:US
Mailing Address - Phone:661-309-7581
Mailing Address - Fax:
Practice Address - Street 1:1700 W CHARLESTON BLVD # D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2335
Practice Address - Country:US
Practice Address - Phone:702-774-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL-470-181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice