Provider Demographics
NPI:1841503273
Name:DR DIEGO AZAR, DMD PA
Entity type:Organization
Organization Name:DR DIEGO AZAR, DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:M
Authorized Official - Last Name:AZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-575-9800
Mailing Address - Street 1:730 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7006
Mailing Address - Country:US
Mailing Address - Phone:954-575-9800
Mailing Address - Fax:954-575-1868
Practice Address - Street 1:730 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7006
Practice Address - Country:US
Practice Address - Phone:954-575-9800
Practice Address - Fax:954-575-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN171201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty