Provider Demographics
NPI:1972086551
Name:ALI JAZAYERI DDS INC
Entity type:Organization
Organization Name:ALI JAZAYERI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:JAZAYERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-481-2540
Mailing Address - Street 1:106 S OLA VISTA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4037
Mailing Address - Country:US
Mailing Address - Phone:949-481-2540
Mailing Address - Fax:949-481-2544
Practice Address - Street 1:106 S OLA VISTA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4037
Practice Address - Country:US
Practice Address - Phone:949-481-2540
Practice Address - Fax:949-481-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental