Provider Demographics
NPI:1811043136
Name:GHAZARIAN DENTAL CLINIC
Entity Type:Organization
Organization Name:GHAZARIAN DENTAL CLINIC
Other - Org Name:K. GHAZARIAN DDS & ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIKOR
Authorized Official - Middle Name:P
Authorized Official - Last Name:GHAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-264-9678
Mailing Address - Street 1:130 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-4839
Mailing Address - Country:US
Mailing Address - Phone:330-264-9678
Mailing Address - Fax:330-264-0890
Practice Address - Street 1:130 S MARKET ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4839
Practice Address - Country:US
Practice Address - Phone:330-264-9678
Practice Address - Fax:330-264-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17656261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2480257Medicaid