Provider Demographics
NPI:1982799276
Name:NARGIZYAN, HOVSEP (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOVSEP
Middle Name:
Last Name:NARGIZYAN
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 1:1655 N. MOUNT VERNON AVE.
Mailing Address - Street 2:UNIT B
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411
Mailing Address - Country:US
Mailing Address - Phone:909-885-8707
Mailing Address - Fax:909-885-9447
Practice Address - Street 1:1655 N. MOUNT VERNON AVE.
Practice Address - Street 2:UNIT B
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411
Practice Address - Country:US
Practice Address - Phone:909-885-8707
Practice Address - Fax:909-885-9447
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619568OtherUNITED CONCORDIA
CAG93081-01Medicare ID - Type UnspecifiedDENTI-CAL