Provider Demographics
NPI:1437229556
Name:EBRAHIMI, AZITA SHEILA (DDS)
Entity Type:Individual
Prefix:DR
First Name:AZITA
Middle Name:SHEILA
Last Name:EBRAHIMI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AZITA
Other - Middle Name:SHEILA
Other - Last Name:LARINAJAFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1740 WEIR DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-738-2125
Mailing Address - Fax:651-738-5902
Practice Address - Street 1:1740 WEIR DRIVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-738-2125
Practice Address - Fax:651-738-5902
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND108751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice