Provider Demographics
NPI:1053391284
Name:AVO A SAMUELIAN DDS PLLC
Entity type:Organization
Organization Name:AVO A SAMUELIAN DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVO
Authorized Official - Middle Name:ARSEN
Authorized Official - Last Name:SAMUELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-253-1850
Mailing Address - Street 1:5 E 19TH ST
Mailing Address - Street 2:5TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-253-1850
Mailing Address - Fax:212-253-0799
Practice Address - Street 1:5 E 19TH ST
Practice Address - Street 2:5TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-253-1850
Practice Address - Fax:212-253-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0481221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty