Provider Demographics
NPI:1386926400
Name:YAZHARI, YASAMIN (DDS)
Entity type:Individual
Prefix:DR
First Name:YASAMIN
Middle Name:
Last Name:YAZHARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26615 US HIGHWAY 380 E STE 130
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-3831
Mailing Address - Country:US
Mailing Address - Phone:403-659-4909
Mailing Address - Fax:
Practice Address - Street 1:4858 SOUTH FWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-3901
Practice Address - Country:US
Practice Address - Phone:817-927-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274121223P0221X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry