Provider Demographics
NPI:1497199145
Name:JOHN M. ABAJIAN DDS A DENTAL CORPORATION
Entity Type:Organization
Organization Name:JOHN M. ABAJIAN DDS A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-991-2626
Mailing Address - Street 1:29219 CANWOOD ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1560
Mailing Address - Country:US
Mailing Address - Phone:818-991-2626
Mailing Address - Fax:818-991-0946
Practice Address - Street 1:29219 CANWOOD ST
Practice Address - Street 2:SUITE 250
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1560
Practice Address - Country:US
Practice Address - Phone:818-991-2626
Practice Address - Fax:818-991-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental