Healthcare Provider Details

I. General information

NPI: 1962189613
Provider Name (Legal Business Name): VARDUHI HOVSEPYAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 SCIENCE PKWY
OKEMOS MI
48864-2551
US

IV. Provider business mailing address

135 S 2ND ST
BRIGHTON MI
48116-1404
US

V. Phone/Fax

Practice location:
  • Phone: 213-399-9711
  • Fax:
Mailing address:
  • Phone: 213-399-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601776
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: