Provider Demographics
NPI:1396985818
Name:REZAZADEH-AZAR, SHARAREH (DDS)
Entity type:Individual
Prefix:DR
First Name:SHARAREH
Middle Name:
Last Name:REZAZADEH-AZAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:AZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15335 BRAUN CT
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3216
Mailing Address - Country:US
Mailing Address - Phone:647-702-1777
Mailing Address - Fax:
Practice Address - Street 1:500 DORIS AVE.
Practice Address - Street 2:SUITE 519
Practice Address - City:TORONTO
Practice Address - State:ON
Practice Address - Zip Code:M2N0C1
Practice Address - Country:CA
Practice Address - Phone:905-891-9372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58069122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist