Provider Demographics
NPI:1699947861
Name:BAZOS, VASILIKI (DDS)
Entity type:Individual
Prefix:DR
First Name:VASILIKI
Middle Name:
Last Name:BAZOS
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 1:23530 HAWTHORNE BLVD SUITE 280
Mailing Address - Street 2:SKYPARK ONE
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-378-1479
Mailing Address - Fax:310-373-6129
Practice Address - Street 1:23530 HAWTHORNE BLVD SUITE 280
Practice Address - Street 2:SKYPARK ONE
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-378-1479
Practice Address - Fax:310-373-6129
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice