Provider Demographics
NPI:1578136578
Name:SHADIE R. AZAR, DMD, MSD,PC
Entity Type:Organization
Organization Name:SHADIE R. AZAR, DMD, MSD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHADIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:AZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MSD
Authorized Official - Phone:909-982-4169
Mailing Address - Street 1:250 E 7TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6603
Mailing Address - Country:US
Mailing Address - Phone:909-982-4169
Mailing Address - Fax:909-981-2149
Practice Address - Street 1:250 E 7TH ST STE D
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6603
Practice Address - Country:US
Practice Address - Phone:909-982-4169
Practice Address - Fax:909-981-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental