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Individual
DR. SHADIE R AZAR
Active
Individual
DR. SHADIE R AZAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS041118
PA
1223P0300X
Periodontics
Primary
105586
CA
390200000X
Student in an Organized Health Care Education/Training Program
3902000000X
PA
Other
Enumeration date
06/03/2015
Last updated
01/12/2021
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