Provider Demographics
NPI:1841207065
Name:AZAR, DIEGO (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:
Last Name:AZAR
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 1:730 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7006
Mailing Address - Country:US
Mailing Address - Phone:954-575-9800
Mailing Address - Fax:954-575-1868
Practice Address - Street 1:730 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7006
Practice Address - Country:US
Practice Address - Phone:954-575-9800
Practice Address - Fax:954-575-1868
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist