Provider Demographics
NPI:1942355599
Name:GARJARIAN, MARCRID (DDS)
Entity Type:Individual
Prefix:
First Name:MARCRID
Middle Name:
Last Name:GARJARIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 48TH ST
Mailing Address - Street 2:AA2
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1648
Mailing Address - Country:US
Mailing Address - Phone:718-706-6022
Mailing Address - Fax:718-706-6012
Practice Address - Street 1:4330 48TH ST
Practice Address - Street 2:AA2
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1648
Practice Address - Country:US
Practice Address - Phone:718-706-6022
Practice Address - Fax:718-706-6012
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0461971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01928638Medicaid