Provider Demographics
NPI:1679755060
Name:EDWARD B. AHN DDS, PC
Entity Type:Organization
Organization Name:EDWARD B. AHN DDS, PC
Other - Org Name:AHN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-855-3000
Mailing Address - Street 1:1680 MCCULLOCH BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-0962
Mailing Address - Country:US
Mailing Address - Phone:928-855-3000
Mailing Address - Fax:928-855-3001
Practice Address - Street 1:1680 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0962
Practice Address - Country:US
Practice Address - Phone:928-855-3000
Practice Address - Fax:928-855-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
AZD6409261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental