Provider Demographics
NPI:1003298894
Name:MICHAEL AYZIN DDS DENTAL CORP
Entity Type:Organization
Organization Name:MICHAEL AYZIN DDS DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AYZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-540-5511
Mailing Address - Street 1:1202 BRISTOL ST STE 120
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-8606
Mailing Address - Country:US
Mailing Address - Phone:714-540-5511
Mailing Address - Fax:714-540-1733
Practice Address - Street 1:1202 BRISTOL ST STE 120
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-8606
Practice Address - Country:US
Practice Address - Phone:714-540-5511
Practice Address - Fax:714-540-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty