Provider Demographics
NPI:1912118878
Name:HAROUT V GOSTANIAN DDS, MSD, PC
Entity Type:Organization
Organization Name:HAROUT V GOSTANIAN DDS, MSD, PC
Other - Org Name:GALLERIA PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROUT
Authorized Official - Middle Name:V
Authorized Official - Last Name:GOSTANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:702-734-5333
Mailing Address - Street 1:731 MALL RING CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6683
Mailing Address - Country:US
Mailing Address - Phone:702-734-5333
Mailing Address - Fax:702-990-0304
Practice Address - Street 1:731 MALL RING CIR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6683
Practice Address - Country:US
Practice Address - Phone:702-734-5333
Practice Address - Fax:702-990-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV200715883511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty