Provider Demographics
NPI:1235258419
Name:MARY AFZALI,D.D.S.,INC.
Entity Type:Organization
Organization Name:MARY AFZALI,D.D.S.,INC.
Other - Org Name:R.B. FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:Z
Authorized Official - Last Name:AFZALI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-485-0044
Mailing Address - Street 1:16776 BERNARDO CENTER DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2534
Mailing Address - Country:US
Mailing Address - Phone:858-485-0044
Mailing Address - Fax:858-485-8150
Practice Address - Street 1:16776 BERNARDO CENTER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2534
Practice Address - Country:US
Practice Address - Phone:858-485-0044
Practice Address - Fax:858-485-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty