Provider Demographics
NPI:1093924755
Name:AZAD, SOHELI ANAR (DDS)
Entity Type:Individual
Prefix:MRS
First Name:SOHELI
Middle Name:ANAR
Last Name:AZAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-02 220TH STREET
Mailing Address - Street 2:PVT HOUSE
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429
Mailing Address - Country:US
Mailing Address - Phone:718-672-5050
Mailing Address - Fax:718-565-5686
Practice Address - Street 1:70-17 37TH AVENUE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-672-5050
Practice Address - Fax:718-565-5686
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047363122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0012254OtherDORAL DENTAL
NY01831667Medicaid