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General NPI Number Information
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NPI Number | 1780502948
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Entity Type | Organization
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Legal Business Name | SEACOVE DENTAL CG PLLC
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Dates
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Enumeration Date | 07/07/2026
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Last Update Date | 07/07/2026
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Provider Practice Location Address
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Address Line | 1348 E FLORENCE BLVD STE 7
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City | CASA GRANDE
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State | AZ
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Zip | 85122-5361
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Country | US
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Telephone | 805-699-1258
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Fax |
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Provider Business Mailing Address
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Address Line | 1348 E FLORENCE BLVD STE 7
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City | CASA GRANDE
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State | AZ
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Zip | 85122-5361
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KOUSHAN AZAD
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Credential | DMD
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Telephone | 805-242-4044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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