Provider Demographics
NPI:1871165258
Name:NJDEH GHAZARYAN PROFESSIONAL DENTAL CORP
Entity type:Organization
Organization Name:NJDEH GHAZARYAN PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NJDEH
Authorized Official - Middle Name:NICK
Authorized Official - Last Name:GHAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-970-5070
Mailing Address - Street 1:18235 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4551
Mailing Address - Country:US
Mailing Address - Phone:818-970-5070
Mailing Address - Fax:
Practice Address - Street 1:18235 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4551
Practice Address - Country:US
Practice Address - Phone:818-970-5070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty