Healthcare Provider Details

I. General information

NPI: 1770011926
Provider Name (Legal Business Name): AZADEH AFSHARI, DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 06/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 S EUCLID AVE BLDG STE 819
SAINT LOUIS MO
63110-1007
US

IV. Provider business mailing address

517 SOUTH EUCLID AVE MCMILLAN BLDG STE 819
SAINT LOUIS MO
63110-1007
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-8574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANN VITALE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 314-362-8574