# REZA AZARI SAMANI, DDS PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114059201
- **Authorized official:** REZA AZARI SAMANI DDS (OWNER)
- **Authorized official phone:** (904) 992-8900

## Contact information

- **Practice address:** 14453 BEACH BLVD., SUITE 100, JACKSONVILLE, FL 32250
- **Practice address phone:** (904) 992-8900
- **Practice address fax:** (904) 992-4922
- **Mailing address:** 14453 BEACH BLVD., SUITE 100, JACKSONVILLE, FL 32250
- **Mailing address phone:** (904) 992-8900
- **Mailing address fax:** (904) 992-4922

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0700X | Prosthodontics | 12860 | FL | Yes |

## Other

- **Enumeration date:** 03/12/2007
- **Last updated:** 06/09/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 69855 | BLUE CROSS BLUE SHIELD | — |
| 01 | — | 826747 | UNITED CONCORDIA | — |