Provider Demographics
NPI:1245620095
Name:GHAZARYAN PROFESSIONAL DENTAL CORP.
Entity Type:Organization
Organization Name:GHAZARYAN PROFESSIONAL DENTAL CORP.
Other - Org Name:ABC KIDS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NJDEH
Authorized Official - Middle Name:NICK
Authorized Official - Last Name:GHAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-970-5070
Mailing Address - Street 1:10445 LAUREL CANYON BLVD.
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-3605
Mailing Address - Country:US
Mailing Address - Phone:818-890-8070
Mailing Address - Fax:818-890-1474
Practice Address - Street 1:8361 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3809
Practice Address - Country:US
Practice Address - Phone:818-890-8070
Practice Address - Fax:818-890-1474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty