Healthcare Provider Details

I. General information

NPI: 1912483389
Provider Name (Legal Business Name): EDMOND ARMAND BEDROSSIAN DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST RM 2618
SAN FRANCISCO CA
94108-4205
US

IV. Provider business mailing address

450 SUTTER ST RM 2618
SAN FRANCISCO CA
94108-4205
US

V. Phone/Fax

Practice location:
  • Phone: 415-505-9860
  • Fax:
Mailing address:
  • Phone: 415-505-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDDS102618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: