Provider Demographics
NPI:1770185845
Name:SOLEIMANZADEH AZAR, PARDIS (DDS)
Entity Type:Individual
Prefix:
First Name:PARDIS
Middle Name:
Last Name:SOLEIMANZADEH AZAR
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 1:138 OLD SAN ANTONIO RD STE 501
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3492
Mailing Address - Country:US
Mailing Address - Phone:830-431-9205
Mailing Address - Fax:
Practice Address - Street 1:138 OLD SAN ANTONIO RD STE 501
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3492
Practice Address - Country:US
Practice Address - Phone:830-431-9205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX389731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics