Provider Demographics
NPI:1891179438
Name:MARY AFZALI,DDS, INC
Entity Type:Organization
Organization Name:MARY AFZALI,DDS, INC
Other - Org Name:R.B. FAMILY & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AFZALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-485-0044
Mailing Address - Street 1:16776 BERNARDO CENTER DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2558
Mailing Address - Country:US
Mailing Address - Phone:858-485-0044
Mailing Address - Fax:
Practice Address - Street 1:16776 BERNARDO CENTER DR STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2558
Practice Address - Country:US
Practice Address - Phone:858-485-0044
Practice Address - Fax:858-227-5717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty