Provider Demographics
NPI:1942332556
Name:AIVAZ, JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:AIVAZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5175 E PACIFIC COAST HWY
Mailing Address - Street 2:405
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3317
Mailing Address - Country:US
Mailing Address - Phone:562-597-8864
Mailing Address - Fax:562-597-4424
Practice Address - Street 1:5175 E PACIFIC COAST HWY
Practice Address - Street 2:405
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3317
Practice Address - Country:US
Practice Address - Phone:562-597-8864
Practice Address - Fax:562-597-4424
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics