Healthcare Provider Details

I. General information

NPI: 1669532925
Provider Name (Legal Business Name): ALI VAZIRI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 VIA DE LA PAZ SUITE C
PACIFIC PALISADES CA
90272-3664
US

IV. Provider business mailing address

4125 SEPULVEDA BLVD
CULVER CITY CA
90230-4706
US

V. Phone/Fax

Practice location:
  • Phone: 310-230-8282
  • Fax: 310-230-8292
Mailing address:
  • Phone: 310-391-6311
  • Fax: 310-390-1874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number39348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: