Provider Demographics
NPI:1467213918
Name:DARRYL T. AZOUZ, D.D.S., INC.
Entity Type:Organization
Organization Name:DARRYL T. AZOUZ, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MERECEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-289-3392
Mailing Address - Street 1:19601 N BLACK CANYON HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4107
Mailing Address - Country:US
Mailing Address - Phone:623-289-3392
Mailing Address - Fax:623-289-2015
Practice Address - Street 1:1077 4TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3486
Practice Address - Country:US
Practice Address - Phone:530-541-1353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental