Provider Demographics
NPI:1700956562
Name:AHN, EDWARD B (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:B
Last Name:AHN
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 1:1680 MCCULLOCH BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-0962
Mailing Address - Country:US
Mailing Address - Phone:928-855-3000
Mailing Address - Fax:928-855-3001
Practice Address - Street 1:1680 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0962
Practice Address - Country:US
Practice Address - Phone:928-855-3000
Practice Address - Fax:928-855-3001
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD64091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice