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General NPI Number Information
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NPI Number | 1780975474
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Entity Type | Organization
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Legal Business Name | MARJANEH H. AZIN D.D.S DENTISTRY FOR CHILDREN AND ADOLESCENTS
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 04/28/2011
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Provider Practice Location Address
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Address Line | 118 NASSAU RD
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City | HUNTINGTON
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State | NY
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Zip | 11743-3614
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Country | US
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Telephone | 631-427-1232
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Fax | 631-427-1211
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Provider Business Mailing Address
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Address Line | 118 NASSAU RD
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City | HUNTINGTON
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State | NY
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Zip | 11743-3614
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Country | US
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Telephone | 631-427-1232
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Fax | 631-427-1211
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Authorized Official
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Title or Position | DENTIST
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Name | MARJANEH HAGHPASSAND-AZIN
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Credential | D.D.S
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Telephone | 631-427-1232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 045301-1
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License Number State | NY
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