Provider Demographics
NPI:1871149930
Name:SHERBANK AZIZI DENTAL CORPORATION
Entity type:Organization
Organization Name:SHERBANK AZIZI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-782-9500
Mailing Address - Street 1:14431 VENTURA BLVD STE 629
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2606
Mailing Address - Country:US
Mailing Address - Phone:818-782-9500
Mailing Address - Fax:
Practice Address - Street 1:6907 LA TIJERA BLVD STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1906
Practice Address - Country:US
Practice Address - Phone:310-645-0336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHERBANK AZIZI DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992804652OtherNPPES
CA1841627825OtherNPPES