Provider Demographics
NPI:1356483002
Name:NABATIAN, AZADEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:AZADEH
Middle Name:
Last Name:NABATIAN
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 1:155 OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3830
Mailing Address - Country:US
Mailing Address - Phone:516-487-4352
Mailing Address - Fax:516-487-4352
Practice Address - Street 1:155 OVERLOOK AVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3830
Practice Address - Country:US
Practice Address - Phone:516-487-4352
Practice Address - Fax:516-487-4352
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02799306Medicaid