Healthcare Provider Details

I. General information

NPI: 1225367907
Provider Name (Legal Business Name): SHARIQ A VAZIR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W ORMOND AVE
CHERRY HILL NJ
08002-3041
US

IV. Provider business mailing address

17 W ORMOND AVE
CHERRY HILL NJ
08002-3041
US

V. Phone/Fax

Practice location:
  • Phone: 856-428-4445
  • Fax: 856-428-4497
Mailing address:
  • Phone: 856-428-4445
  • Fax: 856-428-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberP44647
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02490200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: