Provider Demographics
NPI:1245544709
Name:AZAR, NICK (DMD)
Entity type:Individual
Prefix:DR
First Name:NICK
Middle Name:
Last Name:AZAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:AZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:427 YORKSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3761
Mailing Address - Country:US
Mailing Address - Phone:314-968-1800
Mailing Address - Fax:
Practice Address - Street 1:11 E LOCKWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-3052
Practice Address - Country:US
Practice Address - Phone:314-968-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009014801122300000X, 1223X0400X
IL0210024901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist