Provider Demographics
NPI:1659041424
Name:GARY K. KEVORKIAN, DDS, MS & NAREG ALEXANDRIAN, DDS, MS
Entity Type:Organization
Organization Name:GARY K. KEVORKIAN, DDS, MS & NAREG ALEXANDRIAN, DDS, MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KEVORKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:818-763-9625
Mailing Address - Street 1:12525 MAGNOLIA BLVD.
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2305
Mailing Address - Country:US
Mailing Address - Phone:818-763-9625
Mailing Address - Fax:818-763-4782
Practice Address - Street 1:12525 MAGNOLIA BLVD.
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-2305
Practice Address - Country:US
Practice Address - Phone:818-763-9625
Practice Address - Fax:818-763-4782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty