Healthcare Provider Details

I. General information

NPI: 1649108937
Provider Name (Legal Business Name): ADAM JAZAERLY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 BRIARFIELD BLVD STE 100
MAUMEE OH
43537-9184
US

IV. Provider business mailing address

4333 BRISTOL DR
TROY MI
48085-4867
US

V. Phone/Fax

Practice location:
  • Phone: 419-430-5064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028395
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: