Provider Demographics
NPI:1619644804
Name:ESAKHARIAN, ARDALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ARDALAN
Middle Name:
Last Name:ESAKHARIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 REXFORD DR APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3154
Mailing Address - Country:US
Mailing Address - Phone:310-403-5945
Mailing Address - Fax:
Practice Address - Street 1:813 FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:S PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2605
Practice Address - Country:US
Practice Address - Phone:626-593-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS107239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist