Provider Demographics
NPI:1508943085
Name:RASULOV, AZIZ (DDS)
Entity Type:Individual
Prefix:
First Name:AZIZ
Middle Name:
Last Name:RASULOV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14025 E EXPOSITION AVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2522
Mailing Address - Country:US
Mailing Address - Phone:303-340-0422
Mailing Address - Fax:
Practice Address - Street 1:550 E THORNTON PKWY
Practice Address - Street 2:#240-A
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2100
Practice Address - Country:US
Practice Address - Phone:303-280-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-87711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1777418OtherUNITED CONCORDIA
CO43475361Medicaid