Provider Demographics
NPI:1255460572
Name:SARKISIAN, EDWARD GREGORY (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:GREGORY
Last Name:SARKISIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:G
Other - Last Name:SARKISIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, PC
Mailing Address - Street 1:22190 GARRISON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2260
Mailing Address - Country:US
Mailing Address - Phone:313-277-8900
Mailing Address - Fax:313-277-8914
Practice Address - Street 1:22190 GARRISON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2260
Practice Address - Country:US
Practice Address - Phone:313-277-8900
Practice Address - Fax:313-277-8914
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-247-6941OtherTAXPAYER IDENTIFICATION #