Provider Demographics
NPI:1639508278
Name:ASHTIANY, AZADEH (DDS)
Entity Type:Individual
Prefix:
First Name:AZADEH
Middle Name:
Last Name:ASHTIANY
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 1:8077 FLORENCE AVE
Mailing Address - Street 2:101
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3826
Mailing Address - Country:US
Mailing Address - Phone:562-381-2442
Mailing Address - Fax:888-977-3635
Practice Address - Street 1:8077 FLORENCE AVE
Practice Address - Street 2:101
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3826
Practice Address - Country:US
Practice Address - Phone:562-381-2442
Practice Address - Fax:888-977-3635
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice