Provider Demographics
NPI:1770612798
Name:JAY M AZLING APDC
Entity type:Organization
Organization Name:JAY M AZLING APDC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:AZLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-814-8587
Mailing Address - Street 1:12622 E SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703
Mailing Address - Country:US
Mailing Address - Phone:562-865-0517
Mailing Address - Fax:562-865-9697
Practice Address - Street 1:12622 E SOUTH STREET
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703
Practice Address - Country:US
Practice Address - Phone:562-865-0517
Practice Address - Fax:562-865-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADJ036221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty