Provider Demographics
NPI:1194989921
Name:HAGOPIAN, HENRY J (DDS)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:J
Last Name:HAGOPIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7518 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4140
Mailing Address - Country:US
Mailing Address - Phone:708-695-9595
Mailing Address - Fax:708-695-9274
Practice Address - Street 1:7518 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4140
Practice Address - Country:US
Practice Address - Phone:708-695-9595
Practice Address - Fax:708-695-9274
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.021346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist