Provider Demographics
NPI:1346785300
Name:DEAN AZZEH D.D.S. INC
Entity Type:Organization
Organization Name:DEAN AZZEH D.D.S. INC
Other - Org Name:FAMILY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EZZ
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:AZZEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, DMEDSC,
Authorized Official - Phone:714-544-0200
Mailing Address - Street 1:16168 BEACH BLVD STE 90
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3847
Mailing Address - Country:US
Mailing Address - Phone:714-544-0200
Mailing Address - Fax:714-544-0204
Practice Address - Street 1:16168 BEACH BLVD STE 90
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3847
Practice Address - Country:US
Practice Address - Phone:714-544-0200
Practice Address - Fax:714-544-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245553072Medicare NSC