| Angela Ayzin Dds And Van Ayzin Dds A Dental Coporation | |
|
815 So Central Ave Suite 10 Glendale CA 91204-2079 | |
| (818) 240-5800 | |
| (818) 240-5801 |
| Full Name | Angela Ayzin Dds And Van Ayzin Dds A Dental Coporation |
|---|---|
| Speciality | Dentist |
| Location | 815 So Central Ave, Glendale, California |
| Authorized Official Name and Position | Yan Ayzin (CORPORATE OFFICER) |
| Authorized Official Contact | 8182405800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angela Ayzin Dds And Van Ayzin Dds A Dental Coporation 815 So Central Ave Suite 10 Glendale CA 91204-2079 Ph: (818) 240-5800 | Angela Ayzin Dds And Van Ayzin Dds A Dental Coporation 815 So Central Ave Suite 10 Glendale CA 91204-2079 Ph: (818) 240-5800 |
| NPI Number | 1164585832 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3577786557 |
|---|---|
| Medicare Enrollment ID | O20140520001096 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164585832 | NPI | - | NPPES |
| G9296401 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 41813 (California) | Secondary |
| 122300000X | Dentist | 34050 (California) | Primary |
| Provider Name | Angela Ayzin |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1710184213 PECOS PAC ID: 4486877461 Enrollment ID: I20140620000777 |
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