Provider Demographics
NPI:1679964159
Name:AZZAWI, MAHER (DDS)
Entity Type:Individual
Prefix:
First Name:MAHER
Middle Name:
Last Name:AZZAWI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10165 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0340
Mailing Address - Country:US
Mailing Address - Phone:909-466-3899
Mailing Address - Fax:909-466-3844
Practice Address - Street 1:10165 FOOTHILL BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0340
Practice Address - Country:US
Practice Address - Phone:909-466-3899
Practice Address - Fax:909-466-3844
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist