Provider Demographics
NPI:1578696183
Name:VAKILI, AZITA (DMD)
Entity Type:Individual
Prefix:DR
First Name:AZITA
Middle Name:
Last Name:VAKILI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 LOMAS SANTA FE DR
Mailing Address - Street 2:3
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1349
Mailing Address - Country:US
Mailing Address - Phone:858-481-5210
Mailing Address - Fax:858-481-0502
Practice Address - Street 1:530 LOMAS SANTA FE DR
Practice Address - Street 2:3
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1349
Practice Address - Country:US
Practice Address - Phone:858-481-5210
Practice Address - Fax:858-481-0502
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA364431223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics