Provider Demographics
NPI:1750405288
Name:DAVIDIAN, E JAN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:E JAN
Middle Name:
Last Name:DAVIDIAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6886 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4218
Mailing Address - Country:US
Mailing Address - Phone:951-682-6030
Mailing Address - Fax:951-682-9243
Practice Address - Street 1:6886 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4218
Practice Address - Country:US
Practice Address - Phone:951-682-6030
Practice Address - Fax:951-682-9243
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADV170571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics