Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | IL | |
N | 122300000X | Dentist | 2901017827 | MI |
Y | 1223P0700X | Prosthodontist | 71000195 | OH |
NPI | 1235286238 |
---|---|
Provider Name | Dr. Shereen Shoukry Azer |
First Address | Columbus, OH 43210-1267 |
Second Address | Columbus, OH 43210-1267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 10/07/2007 |