Provider Demographics
NPI:1669670931
Name:AZZEH, EZZ (DDS, CERT, DMSC)
Entity Type:Individual
Prefix:
First Name:EZZ
Middle Name:
Last Name:AZZEH
Suffix:
Gender:M
Credentials:DDS, CERT, DMSC
Other - Prefix:
Other - First Name:DEAN
Other - Middle Name:
Other - Last Name:AZZEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, INC
Mailing Address - Street 1:535 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4453
Mailing Address - Country:US
Mailing Address - Phone:714-544-0200
Mailing Address - Fax:714-509-1517
Practice Address - Street 1:535 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4453
Practice Address - Country:US
Practice Address - Phone:714-544-0200
Practice Address - Fax:714-509-1517
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics