Healthcare Provider Details

I. General information

NPI: 1720775976
Provider Name (Legal Business Name): AZARIAS CEDRION VASSER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 MEMORIAL DR
WAYCROSS GA
31501-0902
US

IV. Provider business mailing address

1 RIVERSIDE AVE APT 3321
JACKSONVILLE FL
32202-5154
US

V. Phone/Fax

Practice location:
  • Phone: 912-550-4124
  • Fax:
Mailing address:
  • Phone: 832-546-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124263.
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: