Provider Demographics
NPI:1184848541
Name:GRIGORYAN, OVSANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:OVSANNA
Middle Name:
Last Name:GRIGORYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 E WEST HWY
Mailing Address - Street 2:STU 400
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2014
Mailing Address - Country:US
Mailing Address - Phone:301-454-0300
Mailing Address - Fax:301-277-4800
Practice Address - Street 1:3600 E WEST HWY
Practice Address - Street 2:STU 400
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2014
Practice Address - Country:US
Practice Address - Phone:301-454-0300
Practice Address - Fax:301-277-4800
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD137521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice