Provider Demographics
NPI:1851453427
Name:GHAZARYAN, NJDEH NICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:NJDEH
Middle Name:NICK
Last Name:GHAZARYAN
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 1:812 E GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1715
Mailing Address - Country:US
Mailing Address - Phone:818-970-5070
Mailing Address - Fax:818-890-1474
Practice Address - Street 1:10445 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-3605
Practice Address - Country:US
Practice Address - Phone:818-970-5070
Practice Address - Fax:818-890-1474
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice