Provider Demographics
NPI:1811311962
Name:AKHAVAN, AZADEH (DDS)
Entity type:Individual
Prefix:DR
First Name:AZADEH
Middle Name:
Last Name:AKHAVAN
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 1:391 CLINTON ST
Mailing Address - Street 2:APT. 4A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3661
Mailing Address - Country:US
Mailing Address - Phone:212-764-0440
Mailing Address - Fax:
Practice Address - Street 1:551 5TH AVE
Practice Address - Street 2:SUITE 625
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10176-0001
Practice Address - Country:US
Practice Address - Phone:212-764-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist