Provider Demographics
NPI:1316508674
Name:ABDESHAHIAN AND NGUYEN DENTAL CORPORATION
Entity type:Organization
Organization Name:ABDESHAHIAN AND NGUYEN DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDESHAHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-771-2982
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:714-845-8500
Mailing Address - Fax:303-952-0892
Practice Address - Street 1:12919 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-4001
Practice Address - Country:US
Practice Address - Phone:714-771-2982
Practice Address - Fax:714-907-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty