Shadie R Azar, D.M.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

105586 Issued in CA

Practice address

250 E 7TH St Ste D
Upland, CA 91786-6685

Phone

(951) 316-3384

Fax

(909) 981-2149

NPI assigned

Jun 3, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shadie R. Azar, DMD, MSD,PC

  • Dental Clinic/Center
  • Upland, CA
  • NPI 1578136578
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1144600289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E 7TH ST STE D",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866685",
            "telephone_number": "909-982-4169",
            "fax_number": "909-981-2149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 E 7TH ST STE D",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866685",
            "telephone_number": "951-316-3384",
            "fax_number": "909-981-2149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZAR",
        "first_name": "SHADIE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-03",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS041118",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "3902000000X",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "105586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley M Ayestas
• Irina Aylyarova
• Jennifer Palarca Ayonon, PHARMD
• Angela Marie Gerez-Martinez Ayson, DPT
• Adly Ayad Azab, MD
• Azhar Majeed M D Inc
• Azriel Palliative and Hospice, Inc
• Azubuike Family Medicine Clinic, a Professional Corporation
• Azubuike Family Medicine Clinic, a Professional Corporation
• Azubuike Family Medicine Clinic, a Professional Corporation

• Periodontics in Upland, CA
• Providers in Upland, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.