Provider Demographics
NPI:1275834871
Name:MIRZOYAN, LILIT (DDS)
Entity Type:Individual
Prefix:MRS
First Name:LILIT
Middle Name:
Last Name:MIRZOYAN
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 1:1127 N PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2358
Mailing Address - Country:US
Mailing Address - Phone:818-272-7529
Mailing Address - Fax:818-551-1167
Practice Address - Street 1:1127 N PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2358
Practice Address - Country:US
Practice Address - Phone:818-551-1127
Practice Address - Fax:818-551-1167
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA599381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice