Provider Demographics
NPI:1972664985
Name:AZIZ, MANAL MICHEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANAL
Middle Name:MICHEL
Last Name:AZIZ
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 1:14150 CULVER DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604
Mailing Address - Country:US
Mailing Address - Phone:949-559-6565
Mailing Address - Fax:949-559-6057
Practice Address - Street 1:14150 CULVER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604
Practice Address - Country:US
Practice Address - Phone:949-559-6565
Practice Address - Fax:949-559-6057
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist