Provider Demographics
NPI:1790138683
Name:MARDIROSSIAN, VANIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:VANIA
Middle Name:
Last Name:MARDIROSSIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3707
Mailing Address - Country:US
Mailing Address - Phone:520-293-9277
Mailing Address - Fax:520-393-3723
Practice Address - Street 1:5209 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3707
Practice Address - Country:US
Practice Address - Phone:520-293-9277
Practice Address - Fax:520-393-3723
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist