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General NPI Number Information
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NPI Number | 1609551944
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Entity Type | Organization
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Legal Business Name | ASCARZADEH DENTAL GROUP
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 13771 NEWPORT AVE STE 11
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City | TUSTIN
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State | CA
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Zip | 92780-4692
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Country | US
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Telephone | 205-515-6666
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 61954
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City | IRVINE
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State | CA
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Zip | 92602-6065
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Country | US
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Telephone | 205-515-6666
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. GHOLAMABBAS ASCARZADEH
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Credential | DMD
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Telephone | 205-515-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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