Provider Demographics
NPI:1104121219
Name:KARAGYOZYAN DDS INC.
Entity type:Organization
Organization Name:KARAGYOZYAN DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YEREVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAGYOZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-628-5962
Mailing Address - Street 1:310 N POMONA AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1928
Mailing Address - Country:US
Mailing Address - Phone:714-992-5490
Mailing Address - Fax:
Practice Address - Street 1:310 N POMONA AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1928
Practice Address - Country:US
Practice Address - Phone:714-992-5490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55925261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental