Provider Demographics
NPI:1417090473
Name:AZANI, DANIEL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:AZANI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25607 MELVILLE CT
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1463
Mailing Address - Country:US
Mailing Address - Phone:661-253-1485
Mailing Address - Fax:
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:#321
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1502
Practice Address - Country:US
Practice Address - Phone:818-783-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics