Provider Demographics
NPI:1720272081
Name:KRIKORIAN, CHARLES R (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:KRIKORIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 NE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7202
Mailing Address - Country:US
Mailing Address - Phone:617-640-4526
Mailing Address - Fax:
Practice Address - Street 1:4410 NE 22ND AVE
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7202
Practice Address - Country:US
Practice Address - Phone:617-640-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist