Provider Demographics
NPI:1811192701
Name:MORRIS AZAD DDS INC.
Entity Type:Organization
Organization Name:MORRIS AZAD DDS INC.
Other - Org Name:MORRIS AKHAMZADEH DMD INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-361-6900
Mailing Address - Street 1:1104 SAN FERNANDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3210
Mailing Address - Country:US
Mailing Address - Phone:818-361-6900
Mailing Address - Fax:818-837-8569
Practice Address - Street 1:1104 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3210
Practice Address - Country:US
Practice Address - Phone:818-361-6900
Practice Address - Fax:818-837-8569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB39932-01Medicaid