Provider Demographics
NPI:1841325164
Name:GHAZARYAN, GHAZAR MIKHAIL (DDS)
Entity type:Individual
Prefix:DR
First Name:GHAZAR
Middle Name:MIKHAIL
Last Name:GHAZARYAN
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 1:1618 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1266
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13746 VICTORY BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6716
Practice Address - Country:US
Practice Address - Phone:818-780-8400
Practice Address - Fax:818-780-2275
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49322122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist