Provider Demographics
NPI:1235347584
Name:AVAKOFF, EDWARD A JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:AVAKOFF
Suffix:JR
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 1:1080 SCOTT BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5237
Mailing Address - Country:US
Mailing Address - Phone:408-246-2550
Mailing Address - Fax:408-246-0339
Practice Address - Street 1:1080 SCOTT BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5237
Practice Address - Country:US
Practice Address - Phone:408-246-2550
Practice Address - Fax:408-246-0339
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics