Provider Demographics
NPI:1811420482
Name:AZ DENTAL GROUP
Entity type:Organization
Organization Name:AZ DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKBASHEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-673-4940
Mailing Address - Street 1:830 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2823
Mailing Address - Country:US
Mailing Address - Phone:215-673-4940
Mailing Address - Fax:
Practice Address - Street 1:1619 GRANT AVE
Practice Address - Street 2:STE 23
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3167
Practice Address - Country:US
Practice Address - Phone:215-673-4940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0374771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty