Provider Demographics
NPI:1477295426
Name:JAZAIRI, YASSER
Entity type:Individual
Prefix:DR
First Name:YASSER
Middle Name:
Last Name:JAZAIRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23036 FL-54 SPC 403, LUTZ, FL 33549
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-2601
Mailing Address - Country:US
Mailing Address - Phone:813-909-1317
Mailing Address - Fax:
Practice Address - Street 1:23036 STATE ROAD 54 STE 403
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-6968
Practice Address - Country:US
Practice Address - Phone:813-909-1317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.0044391223G0001X
FL295211223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice