Provider Demographics
NPI:1487864112
Name:KHANIJOW, BRIJ M
Entity Type:Individual
Prefix:DR
First Name:BRIJ
Middle Name:M
Last Name:KHANIJOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 E BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-5417
Mailing Address - Country:US
Mailing Address - Phone:813-985-0088
Mailing Address - Fax:
Practice Address - Street 1:5411 E BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5417
Practice Address - Country:US
Practice Address - Phone:813-985-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 11472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN 11472OtherFLORIDA DENTAL LICENSE