Provider Demographics
NPI:1003286378
Name:AZAR, MAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAL
Middle Name:
Last Name:AZAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1427
Mailing Address - Country:US
Mailing Address - Phone:201-451-6727
Mailing Address - Fax:
Practice Address - Street 1:88 MORGAN ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1427
Practice Address - Country:US
Practice Address - Phone:201-451-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI026415001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry