Provider Demographics
NPI:1194989756
Name:SALEEM, AZRA (DDS)
Entity type:Individual
Prefix:
First Name:AZRA
Middle Name:
Last Name:SALEEM
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 1:341 N COLONY ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3170
Mailing Address - Country:US
Mailing Address - Phone:203-626-9565
Mailing Address - Fax:203-626-9564
Practice Address - Street 1:341 N COLONY ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-3170
Practice Address - Country:US
Practice Address - Phone:203-626-9565
Practice Address - Fax:203-626-9564
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009906122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist