Provider Demographics
NPI:1669584330
Name:ABDOYAN, DICKRAN THOMAS (DDS)
Entity type:Individual
Prefix:MR
First Name:DICKRAN
Middle Name:THOMAS
Last Name:ABDOYAN
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 1:321 E ALAMEDA AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2616
Mailing Address - Country:US
Mailing Address - Phone:818-842-2747
Mailing Address - Fax:818-842-8331
Practice Address - Street 1:321 E ALAMEDA AVE
Practice Address - Street 2:SUITE J
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2616
Practice Address - Country:US
Practice Address - Phone:818-842-2747
Practice Address - Fax:818-842-8331
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADB28642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD28642Medicare ID - Type Unspecified