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General NPI Number Information
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NPI Number | 1487390167
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Entity Type | Individual
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Provider Name | YARA ABDELAZIZ DMD
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Gender | Female
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 13127 KINGS LAKE DR UNIT 101
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City | GIBSONTON
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State | FL
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Zip | 33534-3958
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Country | US
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Telephone | 813-677-3047
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Fax |
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Provider Business Mailing Address
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Address Line | 2428 CASONA LN APT 6307
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City | MELBOURNE
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State | FL
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Zip | 32940-7579
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Country | US
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Telephone | 954-330-4100
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 27710
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License Number State | FL
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