Provider Demographics
NPI:1205129335
Name:DADASHYAN, ALEKSANDR G
Entity type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:G
Last Name:DADASHYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 COLDWATER CANYON AVE UNIT 302
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1042
Mailing Address - Country:US
Mailing Address - Phone:832-774-5986
Mailing Address - Fax:
Practice Address - Street 1:2800 W MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3036
Practice Address - Country:US
Practice Address - Phone:832-774-5986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2022-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00265081223G0001X
CA603901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice