Individual
DR. AZZAH WIDATALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5455 WILSHIRE BLVD STE 850, LOS ANGELES, CA 90036-4234
(323) 930-4600
Mailing address
428 N OGDEN DR APT 4, LOS ANGELES, CA 90036-1726
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
105590
CA
Other
Enumeration date
10/01/2020
Last updated
10/01/2020
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