Provider Demographics
NPI:1285273284
Name:DARRYL TODD AZOUZ, DDS, INC
Entity type:Organization
Organization Name:DARRYL TODD AZOUZ, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:AZOUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-961-3383
Mailing Address - Street 1:6661 STANFORD RANCH RD STE D
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2675
Mailing Address - Country:US
Mailing Address - Phone:916-630-1084
Mailing Address - Fax:
Practice Address - Street 1:6661 STANFORD RANCH RD STE D
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2675
Practice Address - Country:US
Practice Address - Phone:916-630-1084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental