Provider Demographics
NPI:1831319367
Name:SERADERIAN, VATCHE (DMD)
Entity type:Individual
Prefix:DR
First Name:VATCHE
Middle Name:
Last Name:SERADERIAN
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 1:84 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2519
Mailing Address - Country:US
Mailing Address - Phone:617-489-1215
Mailing Address - Fax:617-489-8736
Practice Address - Street 1:84 LEONARD ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-2519
Practice Address - Country:US
Practice Address - Phone:617-489-1215
Practice Address - Fax:617-489-8736
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist