Provider Demographics
NPI:1982715173
Name:JAMSHID AZIZZADEH DDS INC
Entity Type:Organization
Organization Name:JAMSHID AZIZZADEH DDS INC
Other - Org Name:ADVANCE DENTAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-789-8989
Mailing Address - Street 1:15030 WHITTIER BLVD # 106
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603
Mailing Address - Country:US
Mailing Address - Phone:562-789-8989
Mailing Address - Fax:562-789-8966
Practice Address - Street 1:15030 WHITTIER BLVD # 106
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603
Practice Address - Country:US
Practice Address - Phone:562-789-8989
Practice Address - Fax:562-789-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty