MEDICARE: DR. MICHAEL AZER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	105326	CA

General Provider Information

NPI Number	:	1366054728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL AZER DMD

Provider Business Mailing Address
First Line	:	7382 SOLSTICE PL
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-8769
Country	:	US
Telephone Number	:	310-349-7637
Fax Number	:

Provider Business Practice Location Address
First Line	:	7270 VICTORIA PARK LN STE 3A
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-1850
Country	:	US
Telephone Number	:	310-349-7637
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	11/20/2023

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