Healthcare Provider Details

I. General information

NPI: 1891700571
Provider Name (Legal Business Name): AVADIS ABRAHAMIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MASSACHUSETTS AVE NW STE 310
WASHINGTON DC
20016-4382
US

IV. Provider business mailing address

4910 MASSACHUSETTS AVE NW STE 310
WASHINGTON DC
20016-4392
US

V. Phone/Fax

Practice location:
  • Phone: 202-363-2465
  • Fax: 202-363-2465
Mailing address:
  • Phone: 202-363-2465
  • Fax: 202-363-2465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4133
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: