Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 114606 | OR |
NPI | 1144231879 |
---|---|
Provider Name | Azita Zadeh |
First Address | Portland, OR 97229-1778 |
Second Address | Portland, OR 97229-1778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 08/07/2007 |