Provider Demographics
NPI:1740669043
Name:JOLOUSJAMSHIDI, BANAFSHEH (DDS)
Entity type:Individual
Prefix:
First Name:BANAFSHEH
Middle Name:
Last Name:JOLOUSJAMSHIDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8251 TIMBLE FALLS DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7774
Mailing Address - Country:US
Mailing Address - Phone:419-575-6337
Mailing Address - Fax:
Practice Address - Street 1:8121 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1441
Practice Address - Country:US
Practice Address - Phone:614-888-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024453122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist