Provider Demographics
NPI:1245099092
Name:OHANES, NOVA HAIG
Entity type:Individual
Prefix:
First Name:NOVA
Middle Name:HAIG
Last Name:OHANES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12440 SYLVAN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3111
Mailing Address - Country:US
Mailing Address - Phone:626-808-6891
Mailing Address - Fax:
Practice Address - Street 1:12440 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3111
Practice Address - Country:US
Practice Address - Phone:626-808-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist