Provider Demographics
NPI:1750563664
Name:BEIZAEE, ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:BEIZAEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ARASH
Other - Middle Name:ANDREW
Other - Last Name:BEIZAEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5421 SHANNON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4808
Mailing Address - Country:US
Mailing Address - Phone:181-768-1357
Mailing Address - Fax:
Practice Address - Street 1:5421 SHANNON RIDGE LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-4808
Practice Address - Country:US
Practice Address - Phone:181-768-1357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist