Provider Demographics
NPI:1649340761
Name:GALFAYAN, RUZANNA (DDS)
Entity type:Individual
Prefix:DR
First Name:RUZANNA
Middle Name:
Last Name:GALFAYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 W. BROADWAY AVE.
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1208
Mailing Address - Country:US
Mailing Address - Phone:818-421-5825
Mailing Address - Fax:
Practice Address - Street 1:445 W BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1208
Practice Address - Country:US
Practice Address - Phone:818-421-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB388391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice