Provider Demographics
NPI:1396466801
Name:FAHEEM QAZI DDS CORP
Entity type:Organization
Organization Name:FAHEEM QAZI DDS CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAHEEM
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-613-3153
Mailing Address - Street 1:4456 VIA PINZON
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2731 MANHATTAN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-1602
Practice Address - Country:US
Practice Address - Phone:310-683-5322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50165OtherDENTAL BOARD OF CALIFORNIA
1336359405OtherNPI
CA55694OtherDENTAL BOARD OF CALIFORNIA
CA100698OtherDENTAL BOARD OF CALIFORNIA
1407300130OtherNPI
1497462220OtherNPI