Provider Demographics
NPI:1548708498
Name:EDRISI, AFARIN ARIA
Entity type:Individual
Prefix:MRS
First Name:AFARIN
Middle Name:ARIA
Last Name:EDRISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 FRUITVILLE RD STE 16
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6418
Mailing Address - Country:US
Mailing Address - Phone:941-343-9777
Mailing Address - Fax:
Practice Address - Street 1:3380 LA SIERRA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5271
Practice Address - Country:US
Practice Address - Phone:951-354-9999
Practice Address - Fax:951-354-6666
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22763122300000X
CA1047491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist