Provider Demographics
NPI:1821156084
Name:AZIN, TINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:AZIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22195 EL PASEO
Mailing Address - Street 2:240
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3951
Mailing Address - Country:US
Mailing Address - Phone:949-709-5437
Mailing Address - Fax:
Practice Address - Street 1:22195 EL PASEO
Practice Address - Street 2:240
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3951
Practice Address - Country:US
Practice Address - Phone:949-709-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry