Organization
FAMILY ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EZZ DEAN AZZEH (ORTHODONTIST/OWNER)
(714) 544-0200
Entity
Organization
Contact information
Practice address
1101 BRYAN AVE, SUITE C, TUSTIN, CA 92780-4401
(714) 544-0200
Mailing address
1101 BRYAN AVE, SUITE C, TUSTIN, CA 92780-4401
(714) 544-0200
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
55883
CA
Other
Enumeration date
03/08/2010
Last updated
03/08/2010
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