Provider Demographics
NPI:1821110446
Name:EDMONDBEDROSSIAN DDS, INC.
Entity Type:Organization
Organization Name:EDMONDBEDROSSIAN DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDROSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-956-6610
Mailing Address - Street 1:450 SUTTER ST
Mailing Address - Street 2:SUITE 2439
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-956-6610
Mailing Address - Fax:415-956-6618
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE 2439
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-956-6610
Practice Address - Fax:415-956-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0346711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA655657OtherUNITED CONCORDIA