Provider Demographics
NPI:1801212568
Name:CHRIS GAZARIAN DDS A DENTAL CORPORATION
Entity Type:Organization
Organization Name:CHRIS GAZARIAN DDS A DENTAL CORPORATION
Other - Org Name:STUDIO DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-980-9990
Mailing Address - Street 1:12626 RIVERSIDE DR
Mailing Address - Street 2:STE 407
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3420
Mailing Address - Country:US
Mailing Address - Phone:818-980-9990
Mailing Address - Fax:818-980-9991
Practice Address - Street 1:12626 RIVERSIDE DR
Practice Address - Street 2:STE 407
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91607-3420
Practice Address - Country:US
Practice Address - Phone:818-980-9990
Practice Address - Fax:818-980-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty