Provider Demographics
NPI:1437260080
Name:AVANESIAN, HAMLET S (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAMLET
Middle Name:S
Last Name:AVANESIAN
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 1:316 E BROADWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1011
Mailing Address - Country:US
Mailing Address - Phone:818-548-7700
Mailing Address - Fax:818-548-7697
Practice Address - Street 1:316 E BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1011
Practice Address - Country:US
Practice Address - Phone:818-548-7700
Practice Address - Fax:818-548-7697
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50563122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC-9338001Medicaid