Provider Demographics
NPI:1568861227
Name:GASHPAROVA DENTAL PRACTICE INC.
Entity Type:Organization
Organization Name:GASHPAROVA DENTAL PRACTICE INC.
Other - Org Name:A-Z DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRASNODARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASHPAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-572-6375
Mailing Address - Street 1:628 N. AZUSA AVE.
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:628 N. AZUSA AVE.
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791
Practice Address - Country:US
Practice Address - Phone:626-966-8408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty