Provider Demographics
NPI:1245459387
Name:AVAKIAN, ARAKSY (DMD MDS)
Entity type:Individual
Prefix:DR
First Name:ARAKSY
Middle Name:
Last Name:AVAKIAN
Suffix:
Gender:F
Credentials:DMD MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 N PACIFIC AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2313
Mailing Address - Country:US
Mailing Address - Phone:818-507-1515
Mailing Address - Fax:818-507-8870
Practice Address - Street 1:1017 N PACIFIC AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2313
Practice Address - Country:US
Practice Address - Phone:818-507-1515
Practice Address - Fax:818-507-8870
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31023CA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA31023Medicare UPIN