Provider Demographics
NPI:1841399508
Name:AZIZI DENTAL CORPORATION
Entity Type:Organization
Organization Name:AZIZI DENTAL CORPORATION
Other - Org Name:FAMILY DENTISTRY AND ORTHODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:DR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-327-0404
Mailing Address - Street 1:14011 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249
Mailing Address - Country:US
Mailing Address - Phone:310-327-0404
Mailing Address - Fax:310-327-1426
Practice Address - Street 1:14011 S VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249
Practice Address - Country:US
Practice Address - Phone:310-327-0404
Practice Address - Fax:310-327-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty