Provider Demographics
NPI:1851773220
Name:YAZBACK, ALI Y (DMD,)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:Y
Last Name:YAZBACK
Suffix:
Gender:M
Credentials:DMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 S DIXIE HWY STE 920
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2996
Mailing Address - Country:US
Mailing Address - Phone:305-670-5100
Mailing Address - Fax:
Practice Address - Street 1:9350 S DIXIE HWY STE 920
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2996
Practice Address - Country:US
Practice Address - Phone:305-670-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11755248-9921122300000X
FLDN21282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist