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General NPI Number Information
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NPI Number | 1356404164
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Entity Type | Organization
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Legal Business Name | MAHER AZZAWI DDS INC.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8599 HAVEN AVE SUITE 101
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4849
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Country | US
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Telephone | 909-466-6710
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Fax | 909-483-5520
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Provider Business Mailing Address
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Address Line | 8599 HAVEN AVE SUITE 101
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4849
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Country | US
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Telephone | 909-466-6710
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Fax | 909-483-5520
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Authorized Official
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Title or Position | CEO
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Name | MAHER AZZAWI
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Credential | DDS
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Telephone | 909-466-6710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 48228
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License Number State | CA
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