Provider Demographics
NPI:1073293049
Name:AZARBANI, AMIR
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:AZARBANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 N GLASNER LN
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2552
Mailing Address - Country:US
Mailing Address - Phone:224-200-2999
Mailing Address - Fax:
Practice Address - Street 1:1600 W GONZALES RD STE C
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-7789
Practice Address - Country:US
Practice Address - Phone:805-755-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist