Provider Demographics
NPI:1568180628
Name:BAZELAIS, NAIVASHA AYANA (DMD)
Entity Type:Individual
Prefix:
First Name:NAIVASHA
Middle Name:AYANA
Last Name:BAZELAIS
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:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-866-0930
Mailing Address - Fax:
Practice Address - Street 1:6216 E SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-9105
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:813-738-9001
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL271801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice