Healthcare Provider Details

I. General information

NPI: 1376002279
Provider Name (Legal Business Name): ZIYAD I DAWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10931 CHAPMAN AVE
GARDEN GROVE CA
92840-3214
US

IV. Provider business mailing address

10931 CHAPMAN AVE
GARDEN GROVE CA
92840-3214
US

V. Phone/Fax

Practice location:
  • Phone: 714-956-0857
  • Fax: 714-956-0885
Mailing address:
  • Phone: 714-956-0857
  • Fax: 714-956-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL DAWOOD
Title or Position: OWNER
Credential: DDS
Phone: 714-956-0857