Provider Demographics
NPI:1356480552
Name:BEZIK, JAKLIN (DDS, MDS,)
Entity type:Individual
Prefix:DR
First Name:JAKLIN
Middle Name:
Last Name:BEZIK
Suffix:
Gender:F
Credentials:DDS, MDS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7073 IDYLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1527
Mailing Address - Country:US
Mailing Address - Phone:703-448-3760
Mailing Address - Fax:703-448-3760
Practice Address - Street 1:11150 FAIRFAX BLVD
Practice Address - Street 2:301
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5066
Practice Address - Country:US
Practice Address - Phone:703-934-4474
Practice Address - Fax:703-934-4705
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105801223P0300X
DCDEN10002971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics