Provider Demographics
NPI:1477897866
Name:AVAKIAN, JOHN H (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:AVAKIAN
Suffix:
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 1:450 SUTTER ST #2428
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108
Mailing Address - Country:US
Mailing Address - Phone:415-664-8667
Mailing Address - Fax:415-242-9166
Practice Address - Street 1:450 SUTTER ST RM 2428
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4210
Practice Address - Country:US
Practice Address - Phone:415-664-8667
Practice Address - Fax:415-242-9166
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist