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General NPI Number Information
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NPI Number | 1760054969
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Entity Type | Individual
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Provider Name | JEFF BUIZASTROW DDS
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Gender | Male
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 615 BAY RIDGE PKWY # 3329
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City | BROOKLYN
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State | NY
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Zip | 11209-3329
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Country | US
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Telephone | 718-745-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 205 WICKER
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City | IRVINE
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State | CA
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Zip | 92618-1170
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Country | US
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Telephone |
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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 | 107613
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 065014
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License Number State | NY
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