Provider Demographics
NPI:1164152369
Name:SYEDA, TASNEEM BIJLI (DMD)
Entity Type:Individual
Prefix:
First Name:TASNEEM
Middle Name:BIJLI
Last Name:SYEDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 SADDLE CLUB WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1695
Mailing Address - Country:US
Mailing Address - Phone:203-979-3042
Mailing Address - Fax:
Practice Address - Street 1:624 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1436
Practice Address - Country:US
Practice Address - Phone:859-253-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY107641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice