Provider Demographics
NPI:1558929869
Name:JAH, TARIQAZIZ BASHIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:TARIQAZIZ
Middle Name:BASHIR
Last Name:JAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 HORSE PEN CREEK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8388
Mailing Address - Country:US
Mailing Address - Phone:336-323-2822
Mailing Address - Fax:336-323-2876
Practice Address - Street 1:1037 HOMELAND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7003
Practice Address - Country:US
Practice Address - Phone:336-272-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-01
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist