Provider Demographics
NPI:1659680619
Name:SHNORHAVORIAN, MISAK SARKIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MISAK
Middle Name:SARKIS
Last Name:SHNORHAVORIAN
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 1:15643 SHERMAN WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4135
Mailing Address - Country:US
Mailing Address - Phone:818-786-2209
Mailing Address - Fax:
Practice Address - Street 1:15643 SHERMAN WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4135
Practice Address - Country:US
Practice Address - Phone:818-786-2209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607091223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist