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General NPI Number Information
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NPI Number | 1801314968
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Entity Type | Organization
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Legal Business Name | AZAR PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3403 E PLAZA BLVD STE F
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City | NATIONAL CITY
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State | CA
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Zip | 91950-4140
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Country | US
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Telephone | 619-267-6599
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Fax | 619-267-6672
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Provider Business Mailing Address
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Address Line | 3403 E PLAZA BLVD STE F
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City | NATIONAL CITY
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State | CA
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Zip | 91950-4140
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Country | US
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Telephone | 619-267-6599
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Fax | 619-267-6672
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Authorized Official
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Title or Position | OWNER
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Name | ZAIHLY AZAR
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Credential | DDS
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Telephone | 619-267-6599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 46745
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License Number State |
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