Provider Demographics
NPI:1295152312
Name:AZER, HANY S (DDS)
Entity type:Individual
Prefix:DR
First Name:HANY
Middle Name:S
Last Name:AZER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 LAKE NONA BLVD APT 515
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7632
Mailing Address - Country:US
Mailing Address - Phone:407-491-2449
Mailing Address - Fax:
Practice Address - Street 1:15835 SHADDOCK DR STE 100
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5778
Practice Address - Country:US
Practice Address - Phone:407-554-4222
Practice Address - Fax:689-407-4086
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN208081223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry