Provider Demographics
NPI:1023523784
Name:TONY BEIZAEE DMD APDC
Entity type:Organization
Organization Name:TONY BEIZAEE DMD APDC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEIZAEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-362-3848
Mailing Address - Street 1:6B LIBERTY ST
Mailing Address - Street 2:SUITE #155
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5834
Mailing Address - Country:US
Mailing Address - Phone:949-362-3848
Mailing Address - Fax:949-362-7540
Practice Address - Street 1:6B LIBERTY ST
Practice Address - Street 2:SUITE #155
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5834
Practice Address - Country:US
Practice Address - Phone:949-362-3848
Practice Address - Fax:949-362-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601281223E0200X
CA532691223G0001X
496071223P0300X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275739310OtherPPO