Provider Demographics
NPI:1053324111
Name:AZAR, MEGAN Z (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:Z
Last Name:AZAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W GROVE ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2080
Mailing Address - Country:US
Mailing Address - Phone:570-585-7111
Mailing Address - Fax:
Practice Address - Street 1:301 W GROVE ST STE 2E
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2080
Practice Address - Country:US
Practice Address - Phone:570-585-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0355131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice