Provider Demographics
NPI:1588077812
Name:AZIZ, FERHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:FERHAN
Middle Name:
Last Name:AZIZ
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 1:1728 DUNLAWTON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-2923
Mailing Address - Country:US
Mailing Address - Phone:386-675-0088
Mailing Address - Fax:
Practice Address - Street 1:1728 DUNLAWTON AVE STE 3
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-2923
Practice Address - Country:US
Practice Address - Phone:386-675-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN246021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery