Provider Demographics
NPI:1063695096
Name:HENRY J. HAGOPIAN D.D.S. P.C.
Entity type:Organization
Organization Name:HENRY J. HAGOPIAN D.D.S. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SOLE SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:HAGOPIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-771-0991
Mailing Address - Street 1:7518 W. NORTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707
Mailing Address - Country:US
Mailing Address - Phone:708-695-9595
Mailing Address - Fax:708-695-9274
Practice Address - Street 1:7518 W. NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707
Practice Address - Country:US
Practice Address - Phone:708-695-9595
Practice Address - Fax:708-695-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3190105441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty