Provider Demographics
NPI:1518352145
Name:AAZAMI, NATASHA (DDS)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:AAZAMI
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 1:5175 HERTFORD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3230
Mailing Address - Country:US
Mailing Address - Phone:248-860-9915
Mailing Address - Fax:
Practice Address - Street 1:21055 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-2205
Practice Address - Country:US
Practice Address - Phone:586-772-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist