Healthcare Provider Details

I. General information

NPI: 1316884695
Provider Name (Legal Business Name): AZNIV LIBARYAN DMD, MAMG, MHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SUNSET WAY
HENDERSON NV
89014-2015
US

IV. Provider business mailing address

1920 E RODEO WALK DR UNIT 141
HOLLADAY UT
84117-6068
US

V. Phone/Fax

Practice location:
  • Phone: 702-968-7076
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: