Provider Demographics
NPI:1851725667
Name:AZAN, NOHAUD NASEEF (DDS)
Entity Type:Individual
Prefix:MR
First Name:NOHAUD
Middle Name:NASEEF
Last Name:AZAN
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 1:1806 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-5159
Mailing Address - Country:US
Mailing Address - Phone:660-826-0263
Mailing Address - Fax:660-826-6553
Practice Address - Street 1:1806 W 11TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5159
Practice Address - Country:US
Practice Address - Phone:660-826-0263
Practice Address - Fax:660-826-6553
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE015420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist