Provider Demographics
NPI:1962189613
Name:HOVSEPYAN, VARDUHI (DDS)
Entity type:Individual
Prefix:DR
First Name:VARDUHI
Middle Name:
Last Name:HOVSEPYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1404
Mailing Address - Country:US
Mailing Address - Phone:213-399-9711
Mailing Address - Fax:
Practice Address - Street 1:2277 SCIENCE PKWY
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2551
Practice Address - Country:US
Practice Address - Phone:213-399-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist