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General NPI Number Information
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NPI Number | 1528503588
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Entity Type | Organization
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Legal Business Name | DEAN AZZEH D.D.S. INC
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Dates
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Enumeration Date | 12/30/2016
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 1441 AVOCADO AVE
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7721
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Country | US
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Telephone | 949-640-0203
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Fax | 949-640-2126
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Provider Business Mailing Address
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Address Line | 1441 AVOCADO AVE
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7721
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Country | US
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Telephone | 949-640-0203
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Fax | 949-640-2126
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Authorized Official
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Title or Position | CEO
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Name | DR. EZZ DEAN AZZEG
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Credential | DDS, DMEDSC,
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Telephone | 714-544-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 55883
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License Number State | CA
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