Provider Demographics
NPI:1841643012
Name:MABJEESH, JASMINE (DDS)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:MABJEESH
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 1:9275 SW 152ND ST STE 206
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1774
Mailing Address - Country:US
Mailing Address - Phone:305-233-3922
Mailing Address - Fax:321-722-1978
Practice Address - Street 1:9275 SW 152ND ST STE 206
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1774
Practice Address - Country:US
Practice Address - Phone:305-233-3922
Practice Address - Fax:305-233-2130
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist