Provider Demographics
NPI:1114568326
Name:GHAZINOOR DDS PROF.CORP
Entity Type:Organization
Organization Name:GHAZINOOR DDS PROF.CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:H
Authorized Official - Last Name:GHAZINOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-877-7761
Mailing Address - Street 1:1711 E VALLEY PKWY STE 1101711E
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2521
Mailing Address - Country:US
Mailing Address - Phone:760-877-7761
Mailing Address - Fax:
Practice Address - Street 1:1711 E VALLEY PKWY STE 110
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2521
Practice Address - Country:US
Practice Address - Phone:760-877-7761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty