Provider Demographics
NPI:1508481730
Name:AZAB, MENA (DDS)
Entity Type:Individual
Prefix:
First Name:MENA
Middle Name:
Last Name:AZAB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 FORGE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3028
Mailing Address - Country:US
Mailing Address - Phone:615-810-4392
Mailing Address - Fax:
Practice Address - Street 1:226 SHADY GROVE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2157
Practice Address - Country:US
Practice Address - Phone:615-889-6816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2023-09-22
Deactivation Date:2020-09-08
Deactivation Code:
Reactivation Date:2020-09-30
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN11364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program