Provider Demographics
NPI:1275803538
Name:MAHER AZZAWI DDS LLC
Entity Type:Organization
Organization Name:MAHER AZZAWI DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHER
Authorized Official - Middle Name:
Authorized Official - Last Name:AZZAWI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-466-3899
Mailing Address - Street 1:10165 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0340
Mailing Address - Country:US
Mailing Address - Phone:909-466-3899
Mailing Address - Fax:909-466-3844
Practice Address - Street 1:10165 FOOTHILL BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0340
Practice Address - Country:US
Practice Address - Phone:909-466-3899
Practice Address - Fax:909-466-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48228261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental