Provider Demographics
NPI:1093317703
Name:BAZERBASHI, JOOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOOD
Middle Name:
Last Name:BAZERBASHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 KILLINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6841
Mailing Address - Country:US
Mailing Address - Phone:832-661-8720
Mailing Address - Fax:
Practice Address - Street 1:604 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6834
Practice Address - Country:US
Practice Address - Phone:407-915-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist