Provider Demographics
NPI:1629098967
Name:BAGDASAROV, ARSEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ARSEN
Middle Name:
Last Name:BAGDASAROV
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 1:650 MAIN ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2435
Mailing Address - Country:US
Mailing Address - Phone:413-253-9582
Mailing Address - Fax:413-253-0796
Practice Address - Street 1:650 MAIN ST
Practice Address - Street 2:STE. 1
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2435
Practice Address - Country:US
Practice Address - Phone:413-253-9582
Practice Address - Fax:413-253-0796
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice