Provider Demographics
NPI:1366819344
Name:BARSOUMIAN, VAHE DIRAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAHE
Middle Name:DIRAN
Last Name:BARSOUMIAN
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 1:1050 S BILL MARTIN DR
Mailing Address - Street 2:APT 22103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-5138
Mailing Address - Country:US
Mailing Address - Phone:408-355-0402
Mailing Address - Fax:
Practice Address - Street 1:1050 S BILL MARTIN DR
Practice Address - Street 2:APT 22103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-5138
Practice Address - Country:US
Practice Address - Phone:408-355-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65024122300000X, 1223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice