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General NPI Number Information
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NPI Number | 1104198324
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Entity Type | Organization
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Legal Business Name | ADISHIAN DENTAL CORPORATION
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 72405 PARKVIEW DR STE. B
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City | PALM DESERT
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State | CA
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Zip | 92260-2716
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Country | US
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Telephone | 760-341-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 200 S OAK KNOLL AVE STE. 101
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City | PASADENA
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State | CA
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Zip | 91101-2912
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Country | US
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Telephone | 626-796-3700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT R ADISHIAN
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Credential | DDS
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Telephone | 760-341-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 27944
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License Number State | CA
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