Provider Demographics
NPI:1942480603
Name:AZARIAN, JACKLYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACKLYN
Middle Name:
Last Name:AZARIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:JACKLYN
Other - Middle Name:
Other - Last Name:KHACHADOORIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1141 N BRAND BLVD
Mailing Address - Street 2:STE 500
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3069
Mailing Address - Country:US
Mailing Address - Phone:818-281-2405
Mailing Address - Fax:
Practice Address - Street 1:1141 N BRAND BLVD STE 500
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3069
Practice Address - Country:US
Practice Address - Phone:818-240-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-11
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist