Provider Demographics
NPI:1184830291
Name:GHALILI, BABAK ROBERT (DMD)
Entity Type:Individual
Prefix:
First Name:BABAK
Middle Name:ROBERT
Last Name:GHALILI
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 1:248 DALY ROAD
Mailing Address - Street 2:
Mailing Address - City:E NORTH PORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-499-6197
Mailing Address - Fax:
Practice Address - Street 1:230 PARK AVENUE
Practice Address - Street 2:SUITE 1164
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10169
Practice Address - Country:US
Practice Address - Phone:212-750-3388
Practice Address - Fax:212-697-3005
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics