Provider Demographics
NPI:1962784090
Name:AZIMI, SHEEVA (DMD)
Entity type:Individual
Prefix:DR
First Name:SHEEVA
Middle Name:
Last Name:AZIMI
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 1:9225 SW HALL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6794
Mailing Address - Country:US
Mailing Address - Phone:503-620-7134
Mailing Address - Fax:503-620-7184
Practice Address - Street 1:9225 SW HALL BLVD STE E
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6794
Practice Address - Country:US
Practice Address - Phone:503-620-7134
Practice Address - Fax:503-620-7184
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist