Provider Demographics
NPI:1770812182
Name:AFSHARI, AZADEH (DDS)
Entity type:Individual
Prefix:
First Name:AZADEH
Middle Name:
Last Name:AFSHARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 S EUCLID AVE
Mailing Address - Street 2:MCMILLAN BLDG SUITE 819
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1007
Mailing Address - Country:US
Mailing Address - Phone:314-362-8574
Mailing Address - Fax:314-747-4635
Practice Address - Street 1:7900 CAMBRIDGE ST
Practice Address - Street 2:APT 21-2D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5502
Practice Address - Country:US
Practice Address - Phone:304-216-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice