Healthcare Provider Details

I. General information

NPI: 1578686796
Provider Name (Legal Business Name): EDWARD WILLIAM DAVIDIAN JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 E NC HIGHWAY 54 SUITE 300
DURHAM NC
27713-7512
US

IV. Provider business mailing address

249 E NC HIGHWAY 54 STE 300
DURHAM NC
27713-2490
US

V. Phone/Fax

Practice location:
  • Phone: 919-354-6220
  • Fax: 919-783-0371
Mailing address:
  • Phone: 919-923-4108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number7270
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: