MEDICARE: MR. GARY CHRISTOPHER BOYAJIAN DDS

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	122300000X	Dentist	013834	NJ

General Provider Information

NPI Number	:	1609887025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY CHRISTOPHER BOYAJIAN DDS

Provider Business Mailing Address
First Line	:	205 WASHINGTON AVE
Second Line	:
City	:	LITTLE FERRY
State	:	NJ
Zip	:	07643-2044
Country	:	US
Telephone Number	:	201-342-8585
Fax Number	:	201-807-9136

Provider Business Practice Location Address
First Line	:	205 WASHINGTON AVE
Second Line	:
City	:	LITTLE FERRY
State	:	NJ
Zip	:	07643-2044
Country	:	US
Telephone Number	:	201-342-8585
Fax Number	:	201-807-9136

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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