Provider Demographics
NPI:1023288347
Name:AZZOUNI, LAITH (DMD)
Entity type:Individual
Prefix:DR
First Name:LAITH
Middle Name:
Last Name:AZZOUNI
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 1:390 SOUTHBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2456
Mailing Address - Country:US
Mailing Address - Phone:508-832-0919
Mailing Address - Fax:
Practice Address - Street 1:390 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501
Practice Address - Country:US
Practice Address - Phone:508-832-0919
Practice Address - Fax:508-832-0426
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN185601223S0112X
MADN18550861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery