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General NPI Number Information
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NPI Number | 1720009848
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Entity Type | Organization
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Legal Business Name | JOHN S BAZOS,D.M.D.,P.A.
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 08/27/2007
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Provider Practice Location Address
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Address Line | 9156 WILES RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-1999
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Country | US
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Telephone | 954-255-2787
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Fax | 954-255-8307
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Provider Business Mailing Address
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Address Line | 9156 WILES RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-1999
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Country | US
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Telephone | 954-255-2787
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Fax | 954-255-8307
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN BAZOS
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Credential | D.M.D.
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Telephone | 954-255-2787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS 12263
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License Number State | FL
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