Provider Demographics
NPI:1750104360
Name:AZDRA LLC
Entity type:Organization
Organization Name:AZDRA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-625-0300
Mailing Address - Street 1:900 ROUTE 50
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2155
Mailing Address - Country:US
Mailing Address - Phone:609-625-0300
Mailing Address - Fax:609-625-5042
Practice Address - Street 1:900 ROUTE 50
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2155
Practice Address - Country:US
Practice Address - Phone:609-625-0300
Practice Address - Fax:609-625-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental