MEDICARE: IZADI & SZETO, A PROFESSIONAL DENTAL CORPORATION

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1427637958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IZADI & SZETO, A PROFESSIONAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	22982 EL TORO RD STE 100
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-4919
Country	:	US
Telephone Number	:	949-305-0202
Fax Number	:	949-305-0203

Provider Business Practice Location Address
First Line	:	22982 EL TORO RD STE 100
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-4919
Country	:	US
Telephone Number	:	949-305-0202
Fax Number	:	949-305-0203

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MR. JASON CHAD RAMIREZ
Credential	:
Telephone Number	:	949-305-0202

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	04/02/2021

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