Provider Demographics
NPI:1851992481
Name:CENTINELA JOSEPH DENTAL GROUP
Entity Type:Organization
Organization Name:CENTINELA JOSEPH DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOESPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-466-9571
Mailing Address - Street 1:2934 1/2 BEVERLY GLEN CIRCLE #451
Mailing Address - Street 2:451
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1724
Mailing Address - Country:US
Mailing Address - Phone:310-695-1589
Mailing Address - Fax:818-782-0402
Practice Address - Street 1:6907 LA TIJERA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1906
Practice Address - Country:US
Practice Address - Phone:310-645-0336
Practice Address - Fax:310-645-9250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TILDEN BAY JOSEPH DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty