Provider Demographics
NPI:1730100280
Name:AFSHARI, HAMID REZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:REZA
Last Name:AFSHARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3875
Mailing Address - Country:US
Mailing Address - Phone:919-286-6960
Mailing Address - Fax:919-623-5304
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-6960
Practice Address - Fax:919-623-5304
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902YAMedicaid
NC89902YAMedicaid
NC2410320Medicare ID - Type Unspecified