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General NPI Number Information
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NPI Number | 1841399508
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Entity Type | Organization
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Legal Business Name | AZIZI DENTAL CORPORATION
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14011 S VAN NESS AVE
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City | GARDENA
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State | CA
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Zip | 90249
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Country | US
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Telephone | 310-327-0404
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Fax | 310-327-1426
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Provider Business Mailing Address
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Address Line | 14011 S VAN NESS AVE
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City | GARDENA
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State | CA
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Zip | 90249
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Country | US
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Telephone | 310-327-0404
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Fax | 310-327-1426
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Authorized Official
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Title or Position | DR
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Name | MR. JOSEPH AZIZI
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Credential | DMD
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Telephone | 310-327-0404
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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 | 39939
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License Number State | CA
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