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General NPI Number Information
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NPI Number | 1588730394
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Entity Type | Organization
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Legal Business Name | AZITA LARINAJAFI, INC
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1740 WEIR DRIVE
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City | WOODBURY
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State | MN
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Zip | 55125
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Country | US
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Telephone | 651-738-2125
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Fax | 651-738-5902
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Provider Business Mailing Address
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Address Line | 1740 WEIR DRIVE
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City | WOODBURY
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State | MN
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Zip | 55125
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Country | US
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Telephone | 651-738-2125
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Fax | 651-738-5902
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. AZITA SHEILA EBRAHIMI
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Credential |
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Telephone | 651-738-2125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D10875
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License Number State | MN
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