Provider Demographics
NPI:1962810358
Name:PAZIRAEI, FATEMEH AZADEH (DMD)
Entity type:Individual
Prefix:
First Name:FATEMEH
Middle Name:AZADEH
Last Name:PAZIRAEI
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 1:1631 GORDON HWY STE 22
Mailing Address - Street 2:AUGUSTA SMILES YOUTH DENTISTRY
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-2230
Mailing Address - Country:US
Mailing Address - Phone:803-434-6567
Mailing Address - Fax:
Practice Address - Street 1:1631 GORDON HIGHWAY
Practice Address - Street 2:AUGUSTA SMILES YOUTH DENTISTRY
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906
Practice Address - Country:US
Practice Address - Phone:706-790-9302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8439122300000X
GADN014950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist