Provider Demographics
NPI:1679813703
Name:BOYADJIAN, SIMON KARNIG (DMD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:KARNIG
Last Name:BOYADJIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 IVY RD
Mailing Address - Street 2:A
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-1736
Mailing Address - Country:US
Mailing Address - Phone:434-971-4013
Mailing Address - Fax:434-293-4170
Practice Address - Street 1:2120 IVY RD
Practice Address - Street 2:A
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-1736
Practice Address - Country:US
Practice Address - Phone:434-971-4013
Practice Address - Fax:434-293-4170
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist