Provider Demographics
NPI:1174262844
Name:POURSHIRAZI & RENZI DENTAL CORPORATION
Entity Type:Organization
Organization Name:POURSHIRAZI & RENZI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:RENZI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-313-5781
Mailing Address - Street 1:46 WOODCREST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0220
Mailing Address - Country:US
Mailing Address - Phone:714-313-5781
Mailing Address - Fax:
Practice Address - Street 1:999 N TUSTIN AVE STE 219
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6506
Practice Address - Country:US
Practice Address - Phone:714-972-1359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty