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Organization
REZA AZARI SAMANI, DDS PA
Active
Organization
REZA AZARI SAMANI, DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REZA AZARI SAMANI DDS (OWNER)
(904) 992-8900
Entity
Organization
Contact information
Practice address
14453 BEACH BLVD., SUITE 100, JACKSONVILLE, FL 32250
(904) 992-8900
(904) 992-4922
Mailing address
14453 BEACH BLVD., SUITE 100, JACKSONVILLE, FL 32250
(904) 992-8900
(904) 992-4922
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
12860
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69855
BLUE CROSS BLUE SHIELD
—
01
—
826747
UNITED CONCORDIA
—
Enumeration date
03/12/2007
Last updated
06/09/2014
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