Provider Demographics
NPI:1285859850
Name:NOHAUD N AZAN DDS PC
Entity Type:Organization
Organization Name:NOHAUD N AZAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOHAUD
Authorized Official - Middle Name:NASEEF
Authorized Official - Last Name:AZAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:660-826-0263
Mailing Address - Street 1:1806 WEST 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301
Mailing Address - Country:US
Mailing Address - Phone:660-826-0263
Mailing Address - Fax:660-826-6553
Practice Address - Street 1:1806 WEST 11TH STREET
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301
Practice Address - Country:US
Practice Address - Phone:660-826-0263
Practice Address - Fax:660-826-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE015420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty