Provider Demographics
NPI:1104656362
Name:DAVOODI, SANAZ (DDS)
Entity type:Individual
Prefix:DR
First Name:SANAZ
Middle Name:
Last Name:DAVOODI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 FAIRMOUNT AVE APT 407
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4760
Mailing Address - Country:US
Mailing Address - Phone:310-666-3257
Mailing Address - Fax:
Practice Address - Street 1:1441 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3343
Practice Address - Country:US
Practice Address - Phone:908-344-5263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI03052800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist