Provider Demographics
NPI:1407279805
Name:AZITA VAKILI D.M.D., A DENTAL CORPORATION
Entity Type:Organization
Organization Name:AZITA VAKILI D.M.D., A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:MOJTABA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESFAHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-473-1957
Mailing Address - Street 1:530 LOMAS SANTA FE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1350
Mailing Address - Country:US
Mailing Address - Phone:858-481-5210
Mailing Address - Fax:
Practice Address - Street 1:530 LOMAS SANTA FE DR STE 3
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1350
Practice Address - Country:US
Practice Address - Phone:858-481-5210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA364431223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578696183OtherNPPES