Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN1855086 | MA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN18560 | FL |
NPI | 1023288347 |
---|---|
Provider Name | Dr. Laith Azzouni |
First Address | Auburn, MA 01501-2456 |
Second Address | Auburn, MA 01501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2008 |
Last Update Date | 28/09/2018 |