Provider Demographics
NPI:1689896458
Name:EZEANI DDS DENTAL CORP
Entity Type:Organization
Organization Name:EZEANI DDS DENTAL CORP
Other - Org Name:EZ DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HYACINTH
Authorized Official - Middle Name:EZEBILO
Authorized Official - Last Name:EZEANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-719-1865
Mailing Address - Street 1:20763 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3313
Mailing Address - Country:US
Mailing Address - Phone:310-719-1865
Mailing Address - Fax:310-464-8304
Practice Address - Street 1:20763 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3313
Practice Address - Country:US
Practice Address - Phone:310-719-1865
Practice Address - Fax:310-464-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA39398122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty