Provider Demographics
NPI:1891570529
Name:AZAM ALEEMUDDIN DDS, INC.
Entity type:Organization
Organization Name:AZAM ALEEMUDDIN DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AZAM
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:ALEEMUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH
Authorized Official - Phone:909-596-6500
Mailing Address - Street 1:21050 STONYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-5012
Mailing Address - Country:US
Mailing Address - Phone:951-907-5694
Mailing Address - Fax:
Practice Address - Street 1:1965 FOOTHILL BLVD STE L
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3502
Practice Address - Country:US
Practice Address - Phone:909-596-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental