Provider Demographics
NPI:1407905730
Name:JAFARNIA, BAHAREH
Entity Type:Individual
Prefix:DR
First Name:BAHAREH
Middle Name:
Last Name:JAFARNIA
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 1:345 BAYSHORE BLVD APT 408
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2385
Mailing Address - Country:US
Mailing Address - Phone:352-219-8189
Mailing Address - Fax:
Practice Address - Street 1:1060 W BUSCH BLVD
Practice Address - Street 2:SUITE #105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7707
Practice Address - Country:US
Practice Address - Phone:813-931-4000
Practice Address - Fax:813-935-6532
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL159891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry