Provider Demographics
NPI:1962624148
Name:KAZARIAN, KHATCHATOUR NORAIRI
Entity type:Individual
Prefix:
First Name:KHATCHATOUR
Middle Name:NORAIRI
Last Name:KAZARIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2339
Mailing Address - Country:US
Mailing Address - Phone:617-783-0500
Mailing Address - Fax:617-783-5514
Practice Address - Street 1:287 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1010
Practice Address - Country:US
Practice Address - Phone:617-783-0500
Practice Address - Fax:617-783-5514
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9187124Q00000X
MA218861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No1223G0001XDental ProvidersDentistGeneral Practice