Provider Demographics
NPI:1265739403
Name:AZHAR, DEEBA SARAH (DDS MD)
Entity type:Individual
Prefix:
First Name:DEEBA
Middle Name:SARAH
Last Name:AZHAR
Suffix:
Gender:F
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15315 COASTAL OAK CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-6443
Mailing Address - Country:US
Mailing Address - Phone:713-385-1392
Mailing Address - Fax:
Practice Address - Street 1:1602 W BAKER RD STE B
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2282
Practice Address - Country:US
Practice Address - Phone:281-838-8433
Practice Address - Fax:281-838-8552
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX322571223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program