Provider Demographics
NPI:1609551944
Name:ASCARZADEH DENTAL GROUP
Entity type:Organization
Organization Name:ASCARZADEH DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHOLAMABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ASCARZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-515-6666
Mailing Address - Street 1:PO BOX 61954
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-6065
Mailing Address - Country:US
Mailing Address - Phone:205-515-6666
Mailing Address - Fax:
Practice Address - Street 1:13771 NEWPORT AVE STE 11
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4692
Practice Address - Country:US
Practice Address - Phone:205-515-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty