Provider Demographics
NPI:1073906467
Name:ESFANDIARINIA, AZADEH (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:AZADEH
Middle Name:
Last Name:ESFANDIARINIA
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 RIVER OVERLOOK COURT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:678-860-5351
Mailing Address - Fax:
Practice Address - Street 1:5975 ROSWELL RD STE D229
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4045
Practice Address - Country:US
Practice Address - Phone:678-701-6753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist