Provider Demographics
NPI:1841482494
Name:ODABASHIAN, NISHAN M (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:NISHAN
Middle Name:M
Last Name:ODABASHIAN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 BRUNDAGE LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-2850
Mailing Address - Country:US
Mailing Address - Phone:661-322-2071
Mailing Address - Fax:
Practice Address - Street 1:3975 S DURANGO DR
Practice Address - Street 2:SUITE 107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4156
Practice Address - Country:US
Practice Address - Phone:702-367-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA393171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics