Provider Demographics
NPI:1437217056
Name:SHARIFI, AZALEA A (DMD)
Entity Type:Individual
Prefix:MRS
First Name:AZALEA
Middle Name:A
Last Name:SHARIFI
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 1:8 FARAWAY FARMS CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3825
Mailing Address - Country:US
Mailing Address - Phone:215-380-4967
Mailing Address - Fax:
Practice Address - Street 1:3801 GERMANTOWN PIKE STE 107
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-4019
Practice Address - Country:US
Practice Address - Phone:610-489-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist