Provider Demographics
NPI:1417167230
Name:HOTZAKORGIAN, WAYNE V (DDS, MSCD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:V
Last Name:HOTZAKORGIAN
Suffix:
Gender:M
Credentials:DDS, MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 N. FRESNO ST., STE. 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-224-5423
Mailing Address - Fax:559-224-5957
Practice Address - Street 1:6307 N. FRESNO ST., STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-224-5423
Practice Address - Fax:559-224-5957
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258081223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics