MEDICARE: MESHIA AZAD D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	41814	CA

General Provider Information

NPI Number	:	1295241164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESHIA AZAD D.D.S.

Provider Business Mailing Address
First Line	:	22855 LAKE FOREST DR STE D
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-1647
Country	:	US
Telephone Number	:	949-458-0393
Fax Number	:	949-458-0607

Provider Business Practice Location Address
First Line	:	22855 LAKE FOREST DR STE D
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-1647
Country	:	US
Telephone Number	:	949-458-0393
Fax Number	:	949-458-0607

Authorized Official
Title or Position	:	D.D.S.
Name	:	DR. MESHIA AZAD
Credential	:	D.D.S.
Telephone Number	:	949-458-0393

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	12/14/2017

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