Provider Demographics
NPI:1891924379
Name:YAZAR, MUSTAFA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:
Last Name:YAZAR
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 1:121 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-1554
Mailing Address - Country:US
Mailing Address - Phone:419-673-0706
Mailing Address - Fax:
Practice Address - Street 1:121 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1554
Practice Address - Country:US
Practice Address - Phone:419-673-0706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300230701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice