Provider Demographics
NPI:1265630065
Name:TERZIAN, EDWARD C (DMD, MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:TERZIAN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 VERDUGO BLVD # 151
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1626
Mailing Address - Country:US
Mailing Address - Phone:310-779-9418
Mailing Address - Fax:
Practice Address - Street 1:5162 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-3932
Practice Address - Country:US
Practice Address - Phone:310-779-9418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOMS791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery