Provider Demographics
NPI:1245498229
Name:PAYDAR, AZADEH (DDS)
Entity type:Individual
Prefix:DR
First Name:AZADEH
Middle Name:
Last Name:PAYDAR
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 1:12729 FOOTHILL BLVD
Mailing Address - Street 2:SUITE # A
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9334
Mailing Address - Country:US
Mailing Address - Phone:909-899-8757
Mailing Address - Fax:909-899-8760
Practice Address - Street 1:12729 FOOTHILL BLVD
Practice Address - Street 2:SUITE # A
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-9334
Practice Address - Country:US
Practice Address - Phone:909-899-8757
Practice Address - Fax:909-899-8760
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39695122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health