Provider Demographics
NPI:1821248444
Name:NAZARYAN, LEONIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONIS
Middle Name:
Last Name:NAZARYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 E LOMITA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1821
Mailing Address - Country:US
Mailing Address - Phone:818-590-0822
Mailing Address - Fax:
Practice Address - Street 1:816 E LOMITA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1821
Practice Address - Country:US
Practice Address - Phone:818-590-0822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice