Provider Demographics
NPI:1902952633
Name:AIVAZIAN, STEVE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:AIVAZIAN
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 1:10805 PARAMOUNT BLVD SUITE B
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241
Mailing Address - Country:US
Mailing Address - Phone:562-869-1686
Mailing Address - Fax:562-861-1672
Practice Address - Street 1:10805 PARAMOUNT BLVD SUITE B
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241
Practice Address - Country:US
Practice Address - Phone:562-869-1686
Practice Address - Fax:562-861-1671
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41887OtherDENTAL LICENSE NUMBER