Provider Demographics
NPI:1679132773
Name:VIRJEE, HAANI MOHAMMED SHAKIL (DDS)
Entity Type:Individual
Prefix:
First Name:HAANI MOHAMMED
Middle Name:SHAKIL
Last Name:VIRJEE
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 1:1533 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2842
Mailing Address - Country:US
Mailing Address - Phone:518-274-3424
Mailing Address - Fax:518-274-3428
Practice Address - Street 1:1533 2ND AVE
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2842
Practice Address - Country:US
Practice Address - Phone:518-274-3424
Practice Address - Fax:518-274-3428
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0614811223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program