Provider Demographics
NPI:1740050202
Name:YEREVAN DENTAL PLLC
Entity type:Organization
Organization Name:YEREVAN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-346-8124
Mailing Address - Street 1:1070 W HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8701
Mailing Address - Country:US
Mailing Address - Phone:517-234-7774
Mailing Address - Fax:517-234-7473
Practice Address - Street 1:1070 W HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8701
Practice Address - Country:US
Practice Address - Phone:517-234-7774
Practice Address - Fax:517-234-7473
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YEREVAN DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental