Organization
AZADEH AFZALI D.D.S, INC.
Active
Other names
SB Lifetime Dental
Organization subpart
No
Provider details
NPI number
Authorized official
AZADEH MARY AFZALI DDS (PRESIDENT)
(909) 881-3336
Entity
Organization
Contact information
Practice address
1918 BUSINESS CENTER DR STE 210, SAN BERNARDINO, CA 92408-3441
(909) 881-3336
(909) 890-9099
Mailing address
1918 BUSINESS CENTER DR STE 210, SAN BERNARDINO, CA 92408-3441
(909) 881-3336
(909) 890-9099
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
64657
CA
1223G0001X
General Practice Dentistry
Primary
55014
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55014
CALIFORNIA DENTAL LICENCE
CA
01
—
64657
CALIFORNIA DENTAL LICENCE
CA
Enumeration date
03/16/2016
Last updated
03/16/2016
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