Provider Demographics
NPI:1962412049
Name:SHAMSIPOUR-AZBARI, ALERIZA J (DDS)
Entity type:Individual
Prefix:MR
First Name:ALERIZA
Middle Name:J
Last Name:SHAMSIPOUR-AZBARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 SW BARNES RD
Mailing Address - Street 2:BARNES DENTAL LLC
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6119
Mailing Address - Country:US
Mailing Address - Phone:503-297-8866
Mailing Address - Fax:503-384-9366
Practice Address - Street 1:7325 SW BARNES RD
Practice Address - Street 2:BARNES DENTAL LLC
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6119
Practice Address - Country:US
Practice Address - Phone:503-297-8866
Practice Address - Fax:503-384-9366
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD75131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR158908Medicaid