Provider Demographics
NPI:1144238395
Name:AZADPUR, MARYAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:AZADPUR
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 1:381 HOPMEADOW ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06089-9692
Mailing Address - Country:US
Mailing Address - Phone:860-658-7548
Mailing Address - Fax:860-658-7516
Practice Address - Street 1:381 HOPMEADOW ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06089-9692
Practice Address - Country:US
Practice Address - Phone:860-658-7548
Practice Address - Fax:860-658-7516
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry