Provider Demographics
NPI:1033271713
Name:BEZAD, PATRICIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:BEZAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:POOPAK
Other - Middle Name:
Other - Last Name:BEZAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1054 HARTER RD.
Mailing Address - Street 2:#5
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2653
Mailing Address - Country:US
Mailing Address - Phone:916-749-0990
Mailing Address - Fax:530-755-9887
Practice Address - Street 1:1054 HARTER RD.
Practice Address - Street 2:#5
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2653
Practice Address - Country:US
Practice Address - Phone:916-749-0990
Practice Address - Fax:530-755-9887
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30890Medicaid