Provider Demographics
NPI:1679106116
Name:MERDAD, YASSER
Entity Type:Individual
Prefix:
First Name:YASSER
Middle Name:
Last Name:MERDAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W UNIVERSITY AVE APT 4412
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5207
Mailing Address - Country:US
Mailing Address - Phone:954-256-4030
Mailing Address - Fax:
Practice Address - Street 1:425 W UNIVERSITY AVE APT 4412
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5207
Practice Address - Country:US
Practice Address - Phone:954-256-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRP2097122300000X
FLDRPM2097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist