Provider Demographics
NPI:1508112285
Name:AVODIAN, EDIT (DDS)
Entity Type:Individual
Prefix:
First Name:EDIT
Middle Name:
Last Name:AVODIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4322 45TH ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2349
Mailing Address - Country:US
Mailing Address - Phone:818-269-6610
Mailing Address - Fax:
Practice Address - Street 1:4322 45TH ST APT 4A
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2349
Practice Address - Country:US
Practice Address - Phone:818-269-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056126122300000X
CA62142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist