Provider Demographics
NPI:1477645877
Name:ARARAT DENTAL
Entity Type:Organization
Organization Name:ARARAT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSSOUFIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-533-0005
Mailing Address - Street 1:3171 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3522
Mailing Address - Country:US
Mailing Address - Phone:201-533-0005
Mailing Address - Fax:201-533-1600
Practice Address - Street 1:3171 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3522
Practice Address - Country:US
Practice Address - Phone:201-533-0005
Practice Address - Fax:201-533-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 195211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8380201Medicaid