Provider Demographics
NPI:1770060105
Name:ESHAGHZADEH, EDWIN (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:ESHAGHZADEH
Suffix:
Gender:
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3662 KATELLA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3189
Mailing Address - Country:US
Mailing Address - Phone:323-612-8164
Mailing Address - Fax:
Practice Address - Street 1:3662 KATELLA AVE STE 202
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3189
Practice Address - Country:US
Practice Address - Phone:323-612-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA197458204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery