Provider Demographics
NPI:1578863395
Name:S. GHAZARIAN DDS., INC.
Entity Type:Organization
Organization Name:S. GHAZARIAN DDS., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-722-2922
Mailing Address - Street 1:433 N MONTEBELLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4222
Mailing Address - Country:US
Mailing Address - Phone:323-722-2922
Mailing Address - Fax:323-722-2760
Practice Address - Street 1:433 N MONTEBELLO BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4222
Practice Address - Country:US
Practice Address - Phone:323-722-2922
Practice Address - Fax:323-722-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35398261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental