Provider Demographics
NPI:1265602395
Name:BOUZOGHLANIAN, VASAG H (DDS)
Entity type:Individual
Prefix:
First Name:VASAG
Middle Name:H
Last Name:BOUZOGHLANIAN
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 1:1060 E GREEN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2408
Mailing Address - Country:US
Mailing Address - Phone:661-466-8866
Mailing Address - Fax:
Practice Address - Street 1:1060 E GREEN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2408
Practice Address - Country:US
Practice Address - Phone:661-466-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2013-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist