Provider Demographics
NPI:1902985450
Name:BISTRITZ, JEROME IRA (DDS)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:IRA
Last Name:BISTRITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4544 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2938
Mailing Address - Country:US
Mailing Address - Phone:786-271-9522
Mailing Address - Fax:
Practice Address - Street 1:6130 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5123
Practice Address - Country:US
Practice Address - Phone:954-973-0990
Practice Address - Fax:954-973-1794
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL95491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery