Provider Demographics
NPI:1568896033
Name:SANOSSIAN, EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:SANOSSIAN
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 1:185 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6426
Mailing Address - Country:US
Mailing Address - Phone:973-226-8060
Mailing Address - Fax:973-226-4078
Practice Address - Street 1:185 FAIRFIELD AVE
Practice Address - Street 2:SUITE 4B
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6426
Practice Address - Country:US
Practice Address - Phone:973-226-8060
Practice Address - Fax:973-226-4078
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22DI016921001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice