Provider Demographics
NPI:1770151474
Name:DZHABIEV, ALAN
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:DZHABIEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11177 N ORACLE RD APT 12104
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-5655
Mailing Address - Country:US
Mailing Address - Phone:925-658-2252
Mailing Address - Fax:
Practice Address - Street 1:140 HIGHWAY 274
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-6045
Practice Address - Country:US
Practice Address - Phone:803-752-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0110641223G0001X
NC130001223G0001X
SC102491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice