Reza Azari Samani, DDS PA
Dentist, Prosthodontics in Jacksonville, FL. Organization (NPI-2).
NPI number1114059201
StatusActive
Last updated in NPPESJun 9, 2014
Details
- NPI
- 1114059201
- Entity type
- Organization (NPI-2)
- Legal business name
- Reza Azari Samani, DDS PA
- Organization subpart
- No
- Enumeration date
- Mar 12, 2007
- Last updated
- Jun 9, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0700X | Dentist, Prosthodontics | 12860 | FL | Yes |
Practice location
14453 Beach Blvd.Suite 100
Jacksonville, FL 32250
Phone 904-992-8900 · Fax 904-992-4922
Mailing address
14453 Beach Blvd.Suite 100
Jacksonville, FL 32250
Phone 904-992-8900 · Fax 904-992-4922
Authorized official
Reza Azari Samani
Owner
9049928900
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