Provider Demographics
NPI:1750661781
Name:GOHARI, BIJAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BIJAN
Middle Name:
Last Name:GOHARI
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 1:635 MADISON AVE
Mailing Address - Street 2:12 FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1009
Mailing Address - Country:US
Mailing Address - Phone:212-371-4575
Mailing Address - Fax:212-308-5182
Practice Address - Street 1:635 MADISON AVE
Practice Address - Street 2:12 FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1009
Practice Address - Country:US
Practice Address - Phone:212-371-4575
Practice Address - Fax:212-308-5182
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY359821223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics