Provider Demographics
NPI:1083276018
Name:ALAZZEH, EMAD KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMAD
Middle Name:KEVIN
Last Name:ALAZZEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 CHESHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-1134
Mailing Address - Country:US
Mailing Address - Phone:650-773-6405
Mailing Address - Fax:
Practice Address - Street 1:4375 FIRST ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-4912
Practice Address - Country:US
Practice Address - Phone:925-294-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS103758122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist