Healthcare Provider Details

I. General information

NPI: 1306835517
Provider Name (Legal Business Name): ARAM MICHAEL AIVAZIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 S ELMHURST RD
MT PROSPECT IL
60056-4241
US

IV. Provider business mailing address

1128 S ELMHURST RD
MT PROSPECT IL
60056-4241
US

V. Phone/Fax

Practice location:
  • Phone: 847-228-5523
  • Fax: 847-228-5536
Mailing address:
  • Phone: 847-228-5523
  • Fax: 847-228-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019-025130
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: