Provider Demographics
NPI:1104606425
Name:AZIZI, NAVID (DDS)
Entity type:Individual
Prefix:
First Name:NAVID
Middle Name:
Last Name:AZIZI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4753
Mailing Address - Country:US
Mailing Address - Phone:408-402-2489
Mailing Address - Fax:
Practice Address - Street 1:3031 W MARCH LN STE 328
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-6562
Practice Address - Country:US
Practice Address - Phone:408-402-2489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist