Provider Demographics
NPI:1962110957
Name:SEDRAKYAN, LUSINE (DMD)
Entity type:Individual
Prefix:
First Name:LUSINE
Middle Name:
Last Name:SEDRAKYAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5227 CRESSLYN RDG
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2600
Mailing Address - Country:US
Mailing Address - Phone:470-363-0111
Mailing Address - Fax:
Practice Address - Street 1:1815 SATELLITE BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5237
Practice Address - Country:US
Practice Address - Phone:770-813-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1228281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice