Provider Demographics
NPI:1972666121
Name:BARDASH, JODY Z (DMD)
Entity Type:Individual
Prefix:MR
First Name:JODY
Middle Name:Z
Last Name:BARDASH
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 1:10-06 SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5732
Mailing Address - Country:US
Mailing Address - Phone:201-797-1555
Mailing Address - Fax:
Practice Address - Street 1:10-06 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5732
Practice Address - Country:US
Practice Address - Phone:201-797-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI16947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist