Provider Demographics
NPI:1720329162
Name:AZADI, MILAD (DMD)
Entity Type:Individual
Prefix:
First Name:MILAD
Middle Name:
Last Name:AZADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2979 W SCHOOL HOUSE LN
Mailing Address - Street 2:APT. K507A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-5401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2979 W SCHOOL HOUSE LN
Practice Address - Street 2:APT. K507A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-5401
Practice Address - Country:US
Practice Address - Phone:949-378-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039093122300000X
NJ22DI02523800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist