Provider Demographics
NPI:1043420565
Name:AZENHEIMER, DAVID ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:AZENHEIMER
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 1:2889 HWY 35
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1516
Mailing Address - Country:US
Mailing Address - Phone:732-264-2117
Mailing Address - Fax:732-264-2117
Practice Address - Street 1:2889 HWY 35
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1516
Practice Address - Country:US
Practice Address - Phone:732-264-2117
Practice Address - Fax:732-264-2117
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02171200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist