Provider Demographics
NPI:1548884109
Name:SAWIRES, SOPHIA AZER (DDS)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:AZER
Last Name:SAWIRES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:AZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:706 W BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-2123
Mailing Address - Country:US
Mailing Address - Phone:714-625-1319
Mailing Address - Fax:
Practice Address - Street 1:6445 PATS RANCH RD STE G
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91752-4439
Practice Address - Country:US
Practice Address - Phone:714-625-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1063661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice