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General NPI Number Information
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NPI Number | 1114031838
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Entity Type | Individual
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Provider Name | DR. REZA JABBARY
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3200 S UNIVERSITY DR
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City | DAVIE
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State | FL
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Zip | 33328-2018
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Country | US
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Telephone | 954-262-1660
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Fax |
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Provider Business Mailing Address
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Address Line | 2946 S UNIVERSITY DR APT 7107
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City | DAVIE
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State | FL
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Zip | 33328-1457
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Country | US
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Telephone | 954-723-7907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 052823-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN17605
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License Number State | FL
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