Provider Demographics
NPI:1073727533
Name:AZIZ, TALA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TALA
Middle Name:
Last Name:AZIZ
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:P.O. BOX 22210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94623-2210
Mailing Address - Country:US
Mailing Address - Phone:510-535-4000
Mailing Address - Fax:510-535-4128
Practice Address - Street 1:3451 E. 12TH ST.
Practice Address - Street 2:1ST FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3425
Practice Address - Country:US
Practice Address - Phone:510-535-3425
Practice Address - Fax:510-536-9453
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist