Provider Demographics
NPI:1922125228
Name:AZIZ, NADIR ADLY (DDS)
Entity Type:Individual
Prefix:MR
First Name:NADIR
Middle Name:ADLY
Last Name:AZIZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4763 NORSTAR BLVD
Mailing Address - Street 2:#318
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:815-453-6043
Mailing Address - Fax:315-622-5810
Practice Address - Street 1:7608 OSWEGO RD
Practice Address - Street 2:#16 BAYBERRY DENTAL OFFICE CENTER
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090
Practice Address - Country:US
Practice Address - Phone:315-622-3300
Practice Address - Fax:315-622-5810
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist