Provider Demographics
NPI:1285946848
Name:AZAD, ALI (D,DS)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:AZAD
Suffix:
Gender:M
Credentials:D,DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13024 TOWN COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-9126
Mailing Address - Country:US
Mailing Address - Phone:703-403-3103
Mailing Address - Fax:
Practice Address - Street 1:13024 TOWN COMMONS DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-9126
Practice Address - Country:US
Practice Address - Phone:703-403-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-11
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist