Provider Demographics
NPI:1710344148
Name:EYVAZI DENTAL CORP.
Entity Type:Organization
Organization Name:EYVAZI DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXI
Authorized Official - Middle Name:
Authorized Official - Last Name:EYVAZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-856-6574
Mailing Address - Street 1:13624 HAWTHORNE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13624 HAWTHORNE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5818
Practice Address - Country:US
Practice Address - Phone:310-856-6574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental