Provider Demographics
NPI:1659416212
Name:AZAR, ALAN T
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:T
Last Name:AZAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 NORTH GREEN MOUNT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OFALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269
Mailing Address - Country:US
Mailing Address - Phone:618-235-3336
Mailing Address - Fax:618-301-4007
Practice Address - Street 1:1480 NORTH GREEN MOUNT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OFALLON
Practice Address - State:IL
Practice Address - Zip Code:62269
Practice Address - Country:US
Practice Address - Phone:618-235-3336
Practice Address - Fax:618-301-4007
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics