Provider Demographics
NPI:1134134729
Name:BAYAZ, ABDUL WALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:WALI
Last Name:BAYAZ
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 1:14435 HAMLIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6205
Mailing Address - Country:US
Mailing Address - Phone:818-781-0004
Mailing Address - Fax:818-787-0035
Practice Address - Street 1:14435 HAMLIN ST STE 104
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6205
Practice Address - Country:US
Practice Address - Phone:818-781-0004
Practice Address - Fax:818-787-0035
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice