Provider Demographics
NPI:1205566080
Name:HAYRAPETYAN, AHARON (DDS)
Entity type:Individual
Prefix:
First Name:AHARON
Middle Name:
Last Name:HAYRAPETYAN
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 1:1100 E BROADWAY STE 302
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1384
Mailing Address - Country:US
Mailing Address - Phone:818-745-2002
Mailing Address - Fax:
Practice Address - Street 1:1100 E BROADWAY STE 302
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1384
Practice Address - Country:US
Practice Address - Phone:818-745-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107508122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist