Provider Demographics
NPI:1033318811
Name:DR ELI DAVIDYAN DMD PC
Entity Type:Organization
Organization Name:DR ELI DAVIDYAN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-922-0778
Mailing Address - Street 1:9 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-922-0778
Mailing Address - Fax:978-922-0810
Practice Address - Street 1:9 BROADWAY
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-922-0778
Practice Address - Fax:978-922-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty