Provider Demographics
NPI:1245553072
Name:FAMILY ORTHODONTICS
Entity type:Organization
Organization Name:FAMILY ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EZZ
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:AZZEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-544-0200
Mailing Address - Street 1:1101 BRYAN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4401
Mailing Address - Country:US
Mailing Address - Phone:714-544-0200
Mailing Address - Fax:
Practice Address - Street 1:1101 BRYAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4401
Practice Address - Country:US
Practice Address - Phone:714-544-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty