Provider Demographics
NPI:1134957772
Name:JAZZAR, JAD (DMD)
Entity type:Individual
Prefix:
First Name:JAD
Middle Name:
Last Name:JAZZAR
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 1:614 W HARMONY PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5141
Mailing Address - Country:US
Mailing Address - Phone:480-584-7739
Mailing Address - Fax:
Practice Address - Street 1:1714 W HUNT HWY STE 100
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85143-5245
Practice Address - Country:US
Practice Address - Phone:480-882-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD012223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist