Provider Demographics
NPI:1619448990
Name:AZITA ANISSI DDS
Entity Type:Organization
Organization Name:AZITA ANISSI DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AZITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANISSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-267-7745
Mailing Address - Street 1:121 SULLYS TRAIL SUITE 1
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534
Mailing Address - Country:US
Mailing Address - Phone:585-267-7745
Mailing Address - Fax:585-267-7748
Practice Address - Street 1:121 SULLYS TRAIL SUITE 1
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534
Practice Address - Country:US
Practice Address - Phone:585-267-7745
Practice Address - Fax:585-267-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01343544Medicaid