Provider Demographics
NPI:1720009848
Name:JOHN S BAZOS,D.M.D.,P.A.
Entity Type:Organization
Organization Name:JOHN S BAZOS,D.M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-255-2787
Mailing Address - Street 1:9156 WILES RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1999
Mailing Address - Country:US
Mailing Address - Phone:954-255-2787
Mailing Address - Fax:954-255-8307
Practice Address - Street 1:9156 WILES RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-1999
Practice Address - Country:US
Practice Address - Phone:954-255-2787
Practice Address - Fax:954-255-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDS 122631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty