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1441 Avocado Ave Newport Beach CA 92660-7721 | |
| (949) 640-0203 | |
| (949) 640-2126 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 1441 Avocado Ave, Newport Beach, California |
| Authorized Official Name and Position | Ezz Dean Azzeg (CEO) |
| Authorized Official Contact | 7145440200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1441 Avocado Ave Newport Beach CA 92660-7721 Ph: (949) 640-0203 | 1441 Avocado Ave Newport Beach CA 92660-7721 Ph: (949) 640-0203 |
| NPI Number | 1528503588 |
|---|---|
| Provider Enumeration Date | 12/30/2016 |
| Last Update Date | 12/30/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528503588 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 55883 (California) | Primary |
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