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General NPI Number Information
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NPI Number | 1619448990
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Entity Type | Organization
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Legal Business Name | AZITA ANISSI DDS
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Dates
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Enumeration Date | 12/11/2018
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 121 SULLYS TRAIL SUITE 1
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City | PITTSFORD
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State | NY
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Zip | 14534
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Country | US
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Telephone | 585-267-7745
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Fax | 585-267-7748
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Provider Business Mailing Address
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Address Line | 121 SULLYS TRAIL SUITE 1
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City | PITTSFORD
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State | NY
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Zip | 14534
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Country | US
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Telephone | 585-267-7745
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Fax | 585-267-7748
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Authorized Official
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Title or Position | DENTIST
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Name | AZITA ANISSI
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Credential | DDS
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Telephone | 585-267-7745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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