Provider Demographics
NPI:1336112168
Name:AZIMI, MAHTAB (DDS)
Entity Type:Individual
Prefix:
First Name:MAHTAB
Middle Name:
Last Name:AZIMI
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 1:433 E 56TH ST
Mailing Address - Street 2:#1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2432
Mailing Address - Country:US
Mailing Address - Phone:212-355-2225
Mailing Address - Fax:212-583-1150
Practice Address - Street 1:433 E 56TH ST
Practice Address - Street 2:#1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2432
Practice Address - Country:US
Practice Address - Phone:212-355-2225
Practice Address - Fax:212-583-1150
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY436141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics