Individual
DR. AHMED ELGAZAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS.
Contact information
Practice address
14051 NEWPORT AVE, B2, TUSTIN, CA 92780-5171
(714) 838-1199
(714) 838-1018
Mailing address
14051 NEWPORT AVE, B2, TUSTIN, CA 92780-5171
(714) 838-1199
(714) 838-1018
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
45853
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139724
UNITED COCORDIA
CA
01
—
B45853-01
MEDICAL
CA
Enumeration date
01/08/2007
Last updated
03/10/2008
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