Provider Demographics
NPI:1255495347
Name:AZOUZ, DARRYL TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:TODD
Last Name:AZOUZ
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 1:5414 SUNRISE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7803
Mailing Address - Country:US
Mailing Address - Phone:530-913-2748
Mailing Address - Fax:916-630-1301
Practice Address - Street 1:5414 SUNRISE BLVD STE D
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7803
Practice Address - Country:US
Practice Address - Phone:530-913-2748
Practice Address - Fax:916-630-1301
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13566012OtherUNITED CONCORDIA ID #