Provider Demographics
NPI:1811627763
Name:KAZARIAN, KHACHATRYAN, AZATYAN, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:KAZARIAN, KHACHATRYAN, AZATYAN, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMLET
Authorized Official - Middle Name:
Authorized Official - Last Name:KHACHATRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-300-5849
Mailing Address - Street 1:1698 CRUICKSHANK DR STE B
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-1462
Mailing Address - Country:US
Mailing Address - Phone:818-300-5849
Mailing Address - Fax:
Practice Address - Street 1:508 W ATEN RD
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-9718
Practice Address - Country:US
Practice Address - Phone:760-355-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental