MEDICARE: SOPHIA AZER SAWIRES DDS

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	1223G0001X	General Practice Dentistry	106366	CA

General Provider Information

NPI Number	:	1548884109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA AZER SAWIRES DDS

Provider Business Mailing Address
First Line	:	706 W BRENTWOOD AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-2123
Country	:	US
Telephone Number	:	714-625-1319
Fax Number	:

Provider Business Practice Location Address
First Line	:	6445 PATS RANCH RD STE G
Second Line	:
City	:	JURUPA VALLEY
State	:	CA
Zip	:	91752-4439
Country	:	US
Telephone Number	:	714-625-1319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	09/09/2021

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