Individual
AZARYAS TADIWOS MANDEFRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3850 JEFFCO BLVD, ARNOLD, MO 63010
(636) 333-3304
(636) 333-3307
Mailing address
3850 JEFFCO BLVD, ARNOLD, MO 63010
(636) 333-3304
(636) 333-3307
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2009032198
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40066124
—
MO
Enumeration date
11/24/2009
Last updated
05/06/2025
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