Provider Demographics
NPI:1316081623
Name:GARABEDIAN, HAMLET CHARMAHALI (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:HAMLET
Middle Name:CHARMAHALI
Last Name:GARABEDIAN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:DR
Other - First Name:HAMLET
Other - Middle Name:
Other - Last Name:CHARMAHALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MD
Mailing Address - Street 1:242 N GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4454
Mailing Address - Country:US
Mailing Address - Phone:818-484-8939
Mailing Address - Fax:818-649-1207
Practice Address - Street 1:242 N GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4454
Practice Address - Country:US
Practice Address - Phone:818-484-8939
Practice Address - Fax:818-649-1207
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022856001223S0112X
MD132991223S0112X
CAOMS721223S0112X
NJ25MA08020700204E00000X
CA95221204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG0945AOtherPTAN