Healthcare Provider Details

I. General information

NPI: 1659446862
Provider Name (Legal Business Name): EDWIN PAPAZIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7616 WINNETKA AVENUE SUITE 1
WINNETKA CA
91306
US

IV. Provider business mailing address

7616 WINNETKA AVE 1
WINNETKA CA
91306-2686
US

V. Phone/Fax

Practice location:
  • Phone: 818-772-6222
  • Fax: 818-772-9640
Mailing address:
  • Phone: 818-772-6222
  • Fax: 818-772-9649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: