Provider Demographics
NPI:1881744407
Name:BOYADZYAN, GEVORK (DDS)
Entity type:Individual
Prefix:DR
First Name:GEVORK
Middle Name:
Last Name:BOYADZYAN
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 1:13521 SHERMAN WAY
Mailing Address - Street 2:UNIT H
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2894
Mailing Address - Country:US
Mailing Address - Phone:818-786-8494
Mailing Address - Fax:818-786-8492
Practice Address - Street 1:13521 SHERMAN WAY
Practice Address - Street 2:UNIT H
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2894
Practice Address - Country:US
Practice Address - Phone:818-786-8494
Practice Address - Fax:818-786-8492
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB-38967Medicare ID - Type UnspecifiedBILLING PROVIDER NUMBER