Azadeh Afzali D.D.S, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

55014 Issued in CA

Legal business name

AZADEH AFZALI D.D.S, INC.

Practice address

1918 Business Center Dr Ste 210
San Bernardino, CA 92408-3441

Phone

(909) 881-3336

Fax

(909) 890-9099

NPI assigned

Mar 16, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Azadeh Mary Afzali, DDSNPI 1275796237

Title

President

Phone

(909) 881-3336

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• SB Lifetime Dental Doing business as

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Azadeh Afzali D.D.S, Inc.

  • Dental Clinic/Center
  • San Bernardino, CA
  • NPI 1245924083
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Azadeh Mary Afzali, DDS

  • General Practice Dentistry
  • Glenview, IL
  • NPI 1275796237

  General Practice

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458086400000",
    "number": "1669833810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1918 BUSINESS CENTER DR STE 210",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083441",
            "telephone_number": "909-881-3336",
            "fax_number": "909-890-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 BUSINESS CENTER DR STE 210",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083441",
            "telephone_number": "909-881-3336",
            "fax_number": "909-890-9099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZADEH AFZALI D.D.S, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-16",
        "last_updated": "2016-03-16",
        "status": "A",
        "authorized_official_last_name": "AFZALI",
        "authorized_official_first_name": "AZADEH",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-881-3336",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "64657",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "55014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA DENTAL LICENCE",
            "identifier": "55014",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA DENTAL LICENCE",
            "identifier": "64657",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SB Lifetime Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria Pia Ayala, LCSW
• Micaela Ayala
• Mindy Ayala
• Ayla Corporation
• Azadeh Afzali D.D.S, Inc.
• Antoinette Azar, M.D.
• Beatriz Azevedo Braga
• Nazanin Azizi Shalbaf, MD
• Bridgitte Babbitt
• Samuel Babikian, DDS

• All providers in San Bernardino, CA
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.