Provider Demographics
NPI:1851326136
Name:ANISSI, AZITA (DDS)
Entity type:Individual
Prefix:
First Name:AZITA
Middle Name:
Last Name:ANISSI
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 1:121 SULLY'S TRAIL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534
Mailing Address - Country:US
Mailing Address - Phone:585-267-7745
Mailing Address - Fax:585-267-7748
Practice Address - Street 1:121 SULLY'S TRAIL
Practice Address - Street 2:SUITE 1
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534
Practice Address - Country:US
Practice Address - Phone:585-267-7745
Practice Address - Fax:585-267-7748
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043423-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist