Provider Demographics
NPI:1518120377
Name:PAYDAR, AZITA (DDS)
Entity Type:Individual
Prefix:
First Name:AZITA
Middle Name:
Last Name:PAYDAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1760
Mailing Address - Country:US
Mailing Address - Phone:949-551-5023
Mailing Address - Fax:
Practice Address - Street 1:6071 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2525
Practice Address - Country:US
Practice Address - Phone:951-680-1777
Practice Address - Fax:951-680-1776
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice