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General NPI Number Information
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NPI Number | 1669833810
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Entity Type | Organization
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Legal Business Name | AZADEH AFZALI D.D.S, INC.
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 1918 BUSINESS CENTER DR STE 210
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3441
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Country | US
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Telephone | 909-881-3336
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Fax | 909-890-9099
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Provider Business Mailing Address
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Address Line | 1918 BUSINESS CENTER DR STE 210
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3441
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Country | US
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Telephone | 909-881-3336
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Fax | 909-890-9099
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Authorized Official
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Title or Position | PRESIDENT
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Name | AZADEH MARY AFZALI
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Credential | DDS
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Telephone | 909-881-3336
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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 | 64657
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 55014
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License Number State | CA
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