MEDICARE: DR. BAHAREH JAFARNIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	15989	FL

General Provider Information

NPI Number	:	1407905730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAHAREH JAFARNIA

Provider Business Mailing Address
First Line	:	345 BAYSHORE BLVD APT 408
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2385
Country	:	US
Telephone Number	:	352-219-8189
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 W BUSCH BLVD
Second Line	:	SUITE #105
City	:	TAMPA
State	:	FL
Zip	:	33612-7707
Country	:	US
Telephone Number	:	813-931-4000
Fax Number	:	813-935-6532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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