Provider Demographics
NPI:1912483389
Name:BEDROSSIAN, EDMOND ARMAND (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:ARMAND
Last Name:BEDROSSIAN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SUTTER ST RM 2618
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4205
Mailing Address - Country:US
Mailing Address - Phone:415-505-9860
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST RM 2618
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4205
Practice Address - Country:US
Practice Address - Phone:415-505-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1026181223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty