| Southbay Dentistry And Orthodontics | |
|
14011 Van Ness Ave Gardena CA 90249-2915 | |
| (310) 327-0404 | |
| (310) 327-1426 |
| Full Name | Southbay Dentistry And Orthodontics |
|---|---|
| Speciality | Dentist |
| Location | 14011 Van Ness Ave, Gardena, California |
| Authorized Official Name and Position | Joseph Azizi (PRESIDENT/OWNER) |
| Authorized Official Contact | 3104669571 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southbay Dentistry And Orthodontics 2934 1/2 Beverly Glen Circle #451 451 Los Angeles CA 90077-1724 Ph: (310) 695-1589 | Southbay Dentistry And Orthodontics 14011 Van Ness Ave Gardena CA 90249-2915 Ph: (310) 327-0404 |
| NPI Number | 1225645252 |
|---|---|
| Provider Enumeration Date | 09/24/2020 |
| Last Update Date | 01/24/2023 |
| Medicare PECOS PAC ID | 0446622716 |
|---|---|
| Medicare Enrollment ID | O20230214003041 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225645252 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | Joseph Azizi |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1992804652 PECOS PAC ID: 9436521192 Enrollment ID: I20230207002254 |
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