Provider Demographics
NPI:1619003936
Name:DEHKORDI, AZAR HOSSEINI (DDS)
Entity Type:Individual
Prefix:DR
First Name:AZAR
Middle Name:HOSSEINI
Last Name:DEHKORDI
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 1:10564 5TH AVE NE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7200
Mailing Address - Country:US
Mailing Address - Phone:206-362-5355
Mailing Address - Fax:206-361-0419
Practice Address - Street 1:10564 5TH AVE NE
Practice Address - Street 2:SUITE 403
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7200
Practice Address - Country:US
Practice Address - Phone:206-362-5355
Practice Address - Fax:206-361-0419
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5021696Medicaid