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General NPI Number Information
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NPI Number | 1851453427
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Entity Type | Individual
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Provider Name | NJDEH NICK GHAZARYAN DDS
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 10445 LAUREL CANYON BLVD
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City | PACOIMA
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State | CA
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Zip | 91331-3605
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Country | US
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Telephone | 818-970-5070
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Fax | 818-890-1474
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Provider Business Mailing Address
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Address Line | 812 E GLENOAKS BLVD
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City | GLENDALE
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State | CA
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Zip | 91207-1715
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Country | US
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Telephone | 818-970-5070
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Fax | 818-890-1474
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 53702
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License Number State | CA
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