Provider Demographics
NPI:1669785994
Name:HALEH AZAR, D.M.D., P.C.
Entity type:Organization
Organization Name:HALEH AZAR, D.M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIENT/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-549-7455
Mailing Address - Street 1:3 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6295
Mailing Address - Country:US
Mailing Address - Phone:617-738-5000
Mailing Address - Fax:
Practice Address - Street 1:3 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6295
Practice Address - Country:US
Practice Address - Phone:617-738-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA180081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty