=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598620197
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERITAGE HARBOUR DENTISTRY, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2025
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7105 SR 64 E, UNIT 102
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-277-4698
-----------------------------------------------------
Fax | 941-213-0822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 660041
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75266-0041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-845-8890
-----------------------------------------------------
Fax | 303-952-0892
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANTHONY A AZADI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 941-277-4698
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------