Provider Demographics
NPI:1770011926
Name:AZADEH AFSHARI, DDS LLC
Entity Type:Organization
Organization Name:AZADEH AFSHARI, DDS LLC
Other - Org Name:ORAL AND MAXILLOFACIAL PROSTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-362-8574
Mailing Address - Street 1:517 SOUTH EUCLID AVE
Mailing Address - Street 2:MCMILLAN BLDG STE 819
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:517 S EUCLID AVE BLDG STE 819
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1007
Practice Address - Country:US
Practice Address - Phone:314-362-8574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty