Healthcare Provider Details

I. General information

NPI: 1770812182
Provider Name (Legal Business Name): AZADEH AFSHARI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 CAMBRIDGE ST APT 21-2D
HOUSTON TX
77054-5502
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 304-216-0246
  • Fax:
Mailing address:
  • Phone: 314-362-8574
  • Fax: 314-747-4635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25037
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: