Provider Demographics
NPI:1629679667
Name:EDUARD AVETISYAN DDS INC
Entity Type:Organization
Organization Name:EDUARD AVETISYAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AVETISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-798-5271
Mailing Address - Street 1:5300 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1131
Mailing Address - Country:US
Mailing Address - Phone:323-798-5271
Mailing Address - Fax:
Practice Address - Street 1:5300 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1131
Practice Address - Country:US
Practice Address - Phone:323-798-5271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty