Provider Demographics
NPI:1518254887
Name:CHANGIZI & ISMAIL DENTAL CORPORATION
Entity Type:Organization
Organization Name:CHANGIZI & ISMAIL DENTAL CORPORATION
Other - Org Name:DENTAL GROUP OF CALIFORNIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANGIZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-453-9100
Mailing Address - Street 1:4952 E KINGS CANYON RD # 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-3896
Mailing Address - Country:US
Mailing Address - Phone:559-453-9100
Mailing Address - Fax:559-453-9200
Practice Address - Street 1:4952 E KINGS CANYON RD # 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3896
Practice Address - Country:US
Practice Address - Phone:559-453-9100
Practice Address - Fax:559-453-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty