Basic Information
| Provider Information | |||||||||
| NPI: | 1962810358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAZIRAEI | ||||||||
| FirstName: | FATEMEH | ||||||||
| MiddleName: | AZADEH | ||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1631 GORDON HWY STE 22 | ||||||||
| Address2: | AUGUSTA SMILES YOUTH DENTISTRY | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309062230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034346567 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1631 GORDON HIGHWAY | ||||||||
| Address2: | AUGUSTA SMILES YOUTH DENTISTRY | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067909302 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2014 | ||||||||
| LastUpdateDate: | 10/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 8439 | SC | N | Dental Providers | Dentist | 122300000X | DN014950 | GA | Y | Dental Providers | Dentist |
No ID Information.