Provider Demographics
NPI:1568553444
Name:ADISHIAN, SCOTT REYNOLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:REYNOLD
Last Name:ADISHIAN
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 1:200 S OAK KNOLL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2912
Mailing Address - Country:US
Mailing Address - Phone:626-796-3700
Mailing Address - Fax:
Practice Address - Street 1:200 S OAK KNOLL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2912
Practice Address - Country:US
Practice Address - Phone:626-796-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279441223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics