Provider Demographics
NPI:1215476338
Name:NASIRY, AZADEH (DMD)
Entity type:Individual
Prefix:DR
First Name:AZADEH
Middle Name:
Last Name:NASIRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3377 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1850
Mailing Address - Country:US
Mailing Address - Phone:213-385-9710
Mailing Address - Fax:
Practice Address - Street 1:3377 WILSHIRE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1850
Practice Address - Country:US
Practice Address - Phone:213-385-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS100971122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist