Provider Demographics
NPI:1205221454
Name:AZOUZ DENTAL CORP., A CALIFORNIA PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:AZOUZ DENTAL CORP., A CALIFORNIA PROFESSIONAL CORPORATION
Other - Org Name:GREENHAVEN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUGALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-248-4253
Mailing Address - Street 1:1390 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8260
Mailing Address - Country:US
Mailing Address - Phone:909-248-4253
Mailing Address - Fax:
Practice Address - Street 1:930 FLORIN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-5001
Practice Address - Country:US
Practice Address - Phone:916-395-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-04
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty