Provider Demographics
NPI:1073406807
Name:YAZJI, DOUNIA MARIAM
Entity type:Individual
Prefix:DR
First Name:DOUNIA
Middle Name:MARIAM
Last Name:YAZJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10430 SW VILLAGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2186
Mailing Address - Country:US
Mailing Address - Phone:772-348-0715
Mailing Address - Fax:
Practice Address - Street 1:10430 SW VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2186
Practice Address - Country:US
Practice Address - Phone:772-348-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN302971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice