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NPI Code Detail

MEDICARE: NAIVASHA AYANA BAZELAIS DMD

MEDICARE: NAIVASHA AYANA BAZELAIS DMD
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
11223G0001XGeneral Practice Dentistry27180FL

General Provider Information

NPI Number : 1568180628
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAIVASHA AYANA BAZELAIS DMD
Provider Business Mailing Address
First Line : PO BOX 82969
Second Line :
City : TAMPA
State : FL
Zip : 33682-2969
Country : US
Telephone Number : 813-866-0930
Fax Number :
Provider Business Practice Location Address
First Line : 6216 E SLIGH AVE
Second Line :
City : TAMPA
State : FL
Zip : 33617-9105
Country : US
Telephone Number : 813-397-5300
Fax Number : 813-738-9001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2022
Last Update Date : 04/28/2023

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Directions to “ NAIVASHA AYANA BAZELAIS DMD” Practice Location

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