Provider Demographics
NPI:1366129645
Name:JANDALI, BAKR (DMD)
Entity type:Individual
Prefix:DR
First Name:BAKR
Middle Name:
Last Name:JANDALI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 HARBORPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6172
Mailing Address - Country:US
Mailing Address - Phone:352-410-0181
Mailing Address - Fax:
Practice Address - Street 1:2575 SW 42ND ST UNIT 104
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1356
Practice Address - Country:US
Practice Address - Phone:352-877-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL281081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice