Provider Demographics
NPI:1386835528
Name:DADOURIAN, VAROUJAN (DDS)
Entity Type:Individual
Prefix:
First Name:VAROUJAN
Middle Name:
Last Name:DADOURIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:VAROUJAN
Other - Last Name:DADOURIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3143 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1424
Mailing Address - Country:US
Mailing Address - Phone:773-465-2922
Mailing Address - Fax:773-465-2998
Practice Address - Street 1:3143 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1424
Practice Address - Country:US
Practice Address - Phone:773-465-2922
Practice Address - Fax:773-465-2998
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist