Provider Demographics
NPI:1427637958
Name:IZADI & SZETO, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:IZADI & SZETO, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-305-0202
Mailing Address - Street 1:22982 EL TORO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4919
Mailing Address - Country:US
Mailing Address - Phone:949-305-0202
Mailing Address - Fax:949-305-0203
Practice Address - Street 1:22982 EL TORO RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4919
Practice Address - Country:US
Practice Address - Phone:949-305-0202
Practice Address - Fax:949-305-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty