Provider Demographics
NPI:1497121651
Name:GAZARYAN, ARSEN (DMD)
Entity Type:Individual
Prefix:
First Name:ARSEN
Middle Name:
Last Name:GAZARYAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 S STOCKBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9685
Mailing Address - Country:US
Mailing Address - Phone:201-492-0997
Mailing Address - Fax:
Practice Address - Street 1:5 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9705
Practice Address - Country:US
Practice Address - Phone:609-646-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02613600122300000X, 122300000X
NJ22DI02613601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist