Provider Demographics
NPI:1003025206
Name:AZZARELLI, MAGDALENA (DDS)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:AZZARELLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 ALBERT DR
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5510
Mailing Address - Country:US
Mailing Address - Phone:408-356-8287
Mailing Address - Fax:
Practice Address - Street 1:1660 HILLSDALE AVE
Practice Address - Street 2:130
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3242
Practice Address - Country:US
Practice Address - Phone:408-267-2550
Practice Address - Fax:408-267-1411
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice