Provider Demographics
NPI:1508046079
Name:BAGHOOMIAN, ZAREH C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZAREH
Middle Name:C
Last Name:BAGHOOMIAN
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 1:1010 N GLENDALE AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2121
Mailing Address - Country:US
Mailing Address - Phone:818-548-0752
Mailing Address - Fax:
Practice Address - Street 1:1010 N GLENDALE AVE STE 206
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-2121
Practice Address - Country:US
Practice Address - Phone:818-548-0752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice