MEDICARE: BETTY AIVAZIAN DDS LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019019768	IL

General Provider Information

NPI Number	:	1346570421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETTY AIVAZIAN DDS LTD

Provider Business Mailing Address
First Line	:	1128 S ELMHURST RD
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-4241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1128 S ELMHURST RD
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-4241
Country	:	US
Telephone Number	:	847-228-5523
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. TALEEN AIVAZIAN
Credential	:
Telephone Number	:	847-228-5523

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	07/18/2025

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