Individual
AMIR AZARISAMANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DMD
Contact information
Practice address
1893 NE NEFF RD, BEND, OR 97701-6112
(541) 382-7981
Mailing address
1893 NE NEFF RD, BEND, OR 97701-6112
(541) 382-7981
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN19828
FL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D9793
OR
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
MD187266
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D9793
OREGON BOARD OF DENTISTRY
OR
01
—
MD187266
OREGON BOARD OF MEDICINE
OR
Enumeration date
04/04/2012
Last updated
08/27/2019
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