Provider Demographics
NPI:1841401668
Name:AZEZA DENTAL P.C.
Entity Type:Organization
Organization Name:AZEZA DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANSOUR
Authorized Official - Middle Name:M
Authorized Official - Last Name:WERFALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-388-0000
Mailing Address - Street 1:410 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5444
Mailing Address - Country:US
Mailing Address - Phone:781-388-0000
Mailing Address - Fax:
Practice Address - Street 1:410 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5444
Practice Address - Country:US
Practice Address - Phone:781-388-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty