Provider Demographics
NPI:1063740108
Name:EDWARD R. ESSAYAN DDS, PC (PROFESSIONAL CORPORATION)
Entity type:Organization
Organization Name:EDWARD R. ESSAYAN DDS, PC (PROFESSIONAL CORPORATION)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS - ORTHODONTIST - PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:ESSAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS - ORTHODONTIST
Authorized Official - Phone:248-851-3767
Mailing Address - Street 1:6161 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2384
Mailing Address - Country:US
Mailing Address - Phone:248-851-3767
Mailing Address - Fax:248-865-9455
Practice Address - Street 1:6161 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2384
Practice Address - Country:US
Practice Address - Phone:248-851-3767
Practice Address - Fax:248-865-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010096791223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty