Provider Demographics
NPI:1750981478
Name:TILDEN BAY JOSEPH DENTAL GROUP
Entity type:Organization
Organization Name:TILDEN BAY JOSEPH DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-466-9571
Mailing Address - Street 1:2934 1/2 BEVERLY GLEN CIRCLE #451
Mailing Address - Street 2:451
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1724
Mailing Address - Country:US
Mailing Address - Phone:310-695-1589
Mailing Address - Fax:818-782-0402
Practice Address - Street 1:14401 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91401-4824
Practice Address - Country:US
Practice Address - Phone:818-782-9500
Practice Address - Fax:818-782-0402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORMANDY BAY JOSEPH DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty