Healthcare Provider Details

I. General information

NPI: 1023523784
Provider Name (Legal Business Name): TONY BEIZAEE DMD APDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 12/13/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6B LIBERTY ST SUITE #155
ALISO VIEJO CA
92656-5834
US

IV. Provider business mailing address

6B LIBERTY ST SUITE #155
ALISO VIEJO CA
92656-5834
US

V. Phone/Fax

Practice location:
  • Phone: 949-362-3848
  • Fax: 949-362-7540
Mailing address:
  • Phone: 949-362-3848
  • Fax: 949-362-7540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number60128
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53269
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number49607
License Number State

VIII. Authorized Official

Name: TONY BEIZAEE
Title or Position: DENTIST
Credential: DMD
Phone: 949-362-3848