Provider Demographics
NPI:1700041324
Name:VAZIRI, ALI A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:A
Last Name:VAZIRI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 U.S. HWY 441
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788
Mailing Address - Country:US
Mailing Address - Phone:352-365-6442
Mailing Address - Fax:352-365-8332
Practice Address - Street 1:10601 US HIGHWAY 441 STE C1B
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-7206
Practice Address - Country:US
Practice Address - Phone:352-365-6442
Practice Address - Fax:352-365-8332
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN14389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist