Provider Demographics
NPI:1386631703
Name:BAZAR, EDWARD JOHN III (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:BAZAR
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SW ARBORWALK BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4101
Mailing Address - Country:US
Mailing Address - Phone:816-623-9999
Mailing Address - Fax:816-623-9998
Practice Address - Street 1:1301 SW ARBORWALK BLVD STE E
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4101
Practice Address - Country:US
Practice Address - Phone:816-623-9999
Practice Address - Fax:816-623-9998
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003025550122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist