Provider Demographics
NPI:1770028201
Name:MAZIAR IZADI DDS INC
Entity Type:Organization
Organization Name:MAZIAR IZADI DDS INC
Other - Org Name:FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAZIAR
Authorized Official - Middle Name:
Authorized Official - Last Name:IZADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-584-2228
Mailing Address - Street 1:495 E LOS ANGELES AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7706
Mailing Address - Country:US
Mailing Address - Phone:805-584-2228
Mailing Address - Fax:805-584-0621
Practice Address - Street 1:495 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-584-2228
Practice Address - Fax:805-584-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63905305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service