Provider Demographics
NPI:1891038808
Name:ADOMIAN, JOHN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:ADOMIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1504
Mailing Address - Country:US
Mailing Address - Phone:310-458-1545
Mailing Address - Fax:310-458-1546
Practice Address - Street 1:919 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1504
Practice Address - Country:US
Practice Address - Phone:310-458-1545
Practice Address - Fax:310-458-1546
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44451122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist