Provider Demographics
NPI:1427350750
Name:DELSHAD, EDWARD A (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:DELSHAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ARDAVAN
Other - Middle Name:
Other - Last Name:DELSHAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9800 VIDOR DR APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1036
Mailing Address - Country:US
Mailing Address - Phone:213-973-2040
Mailing Address - Fax:
Practice Address - Street 1:1304 15TH ST STE 206
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1811
Practice Address - Country:US
Practice Address - Phone:310-451-5748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA599531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice