Provider Demographics
NPI:1558568337
Name:NIA, AZI SOLTANI
Entity Type:Individual
Prefix:
First Name:AZI
Middle Name:SOLTANI
Last Name:NIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PROMINENCE POINT PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9108
Mailing Address - Country:US
Mailing Address - Phone:770-479-9999
Mailing Address - Fax:770-479-9990
Practice Address - Street 1:150 PROMINENCE POINT PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-9108
Practice Address - Country:US
Practice Address - Phone:770-479-9999
Practice Address - Fax:770-479-9990
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice