Provider Demographics
NPI:1992890966
Name:BLEIWEISS, YASSAMAN DOROSTI (DDS)
Entity type:Individual
Prefix:
First Name:YASSAMAN
Middle Name:DOROSTI
Last Name:BLEIWEISS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:YASSAMIN
Other - Middle Name:
Other - Last Name:DOROSTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2695 MAYSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-8575
Mailing Address - Country:US
Mailing Address - Phone:740-452-3697
Mailing Address - Fax:740-452-9211
Practice Address - Street 1:2695 MAYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-8575
Practice Address - Country:US
Practice Address - Phone:740-452-3697
Practice Address - Fax:740-452-9211
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30217481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice