Provider Demographics
NPI:1770977704
Name:AZAR, JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:AZAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 EDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4835
Mailing Address - Country:US
Mailing Address - Phone:314-740-0780
Mailing Address - Fax:
Practice Address - Street 1:11 E LOCKWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-3052
Practice Address - Country:US
Practice Address - Phone:314-968-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150042561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1223G0001XDental ProvidersDentistGeneral Practice