Provider Demographics
NPI:1356655765
Name:EDVIN AGADZHANOV DDS INC
Entity Type:Organization
Organization Name:EDVIN AGADZHANOV DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGADZHANOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-267-7571
Mailing Address - Street 1:18984 SOLEDAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3360
Mailing Address - Country:US
Mailing Address - Phone:661-251-5556
Mailing Address - Fax:
Practice Address - Street 1:18984 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3360
Practice Address - Country:US
Practice Address - Phone:661-251-5556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA572331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty