Provider Demographics
NPI:1568484947
Name:MOORADIAN, GAYANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAYANE
Middle Name:
Last Name:MOORADIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WATER ST
Mailing Address - Street 2:SUITE J-1
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4124
Mailing Address - Country:US
Mailing Address - Phone:831-425-5515
Mailing Address - Fax:831-425-8567
Practice Address - Street 1:550 WATER ST
Practice Address - Street 2:SUITE J-1
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4124
Practice Address - Country:US
Practice Address - Phone:831-425-5515
Practice Address - Fax:831-425-8567
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice