Individual
DR. SHADIE R AZAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
250 E 7TH ST STE D, UPLAND, CA 91786-6685
(951) 316-3384
(909) 981-2149
Mailing address
250 E 7TH ST STE D, UPLAND, CA 91786-6685
(909) 982-4169
(909) 981-2149
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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