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General NPI Number Information
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NPI Number | 1790393890
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Entity Type | Organization
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Legal Business Name | DEERFIELD MODERN DENTISTRY, PA
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Dates
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Enumeration Date | 07/15/2020
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 778 S FEDERAL HWY
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-5767
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Country | US
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Telephone | 754-333-2966
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Fax | 754-333-4026
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Provider Business Mailing Address
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Address Line | PO BOX 920050
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City | DALLAS
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State | TX
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Zip | 75392-0050
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Country | US
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Telephone | 714-845-8890
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Fax | 303-952-0892
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY AZADI
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Credential | DDS
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Telephone | 754-333-2966
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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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