Provider Demographics
NPI:1104198324
Name:ADISHIAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:ADISHIAN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADISHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-341-9400
Mailing Address - Street 1:200 S OAK KNOLL AVE
Mailing Address - Street 2:STE. 101
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2912
Mailing Address - Country:US
Mailing Address - Phone:626-796-3700
Mailing Address - Fax:
Practice Address - Street 1:72405 PARKVIEW DR
Practice Address - Street 2:STE. B
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2716
Practice Address - Country:US
Practice Address - Phone:760-341-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279441223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty