Provider Demographics
NPI:1922121177
Name:AZADIVATAN-LE, NEDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEDA
Middle Name:
Last Name:AZADIVATAN-LE
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:PO BOX 15639
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29587-5639
Mailing Address - Country:US
Mailing Address - Phone:843-650-7171
Mailing Address - Fax:843-650-7173
Practice Address - Street 1:1947 GLENNS BAY RD
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4833
Practice Address - Country:US
Practice Address - Phone:843-650-7171
Practice Address - Fax:843-650-7173
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0492271223P0300X
SC103871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics