Provider Demographics
NPI:1013137116
Name:STEPANIAN, MARDIROS Y (DDS)
Entity type:Individual
Prefix:
First Name:MARDIROS
Middle Name:Y
Last Name:STEPANIAN
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 1:305 N PECOS RD
Mailing Address - Street 2:#F
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89076
Mailing Address - Country:US
Mailing Address - Phone:702-896-6945
Mailing Address - Fax:702-896-0106
Practice Address - Street 1:305 N PECOS RD
Practice Address - Street 2:#F
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89076
Practice Address - Country:US
Practice Address - Phone:702-896-6945
Practice Address - Fax:702-896-0106
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35131223G0001X
CA428891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice