Provider Demographics
NPI:1780950287
Name:FLOYD, JAZMIN TYSHEEMAH (DMD)
Entity type:Individual
Prefix:DR
First Name:JAZMIN
Middle Name:TYSHEEMAH
Last Name:FLOYD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12705 THERESA DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3561
Mailing Address - Country:US
Mailing Address - Phone:908-472-5358
Mailing Address - Fax:
Practice Address - Street 1:13135 LEE JACKSON MEMORIAL HWY STE 110
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1909
Practice Address - Country:US
Practice Address - Phone:703-436-1010
Practice Address - Fax:703-436-1122
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014139451223G0001X, 1223P0221X
NJ22D1025300001223G0001X
TX347991223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program