Provider Demographics
NPI:1659437036
Name:GHALCHI, AZITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:AZITA
Middle Name:
Last Name:GHALCHI
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 1:50 PALATINE APT 210
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-5627
Mailing Address - Country:US
Mailing Address - Phone:949-336-8697
Mailing Address - Fax:
Practice Address - Street 1:50 PALATINE APT 210
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-5627
Practice Address - Country:US
Practice Address - Phone:949-336-8697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice