Provider Demographics
NPI:1871677583
Name:MARK S. BICHAJIAN, DMD, INC.
Entity Type:Organization
Organization Name:MARK S. BICHAJIAN, DMD, INC.
Other - Org Name:PROFESSIONAL DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIAVULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-785-2111
Mailing Address - Street 1:708 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-2670
Mailing Address - Country:US
Mailing Address - Phone:401-785-2111
Mailing Address - Fax:401-941-1547
Practice Address - Street 1:708 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-2670
Practice Address - Country:US
Practice Address - Phone:401-785-2111
Practice Address - Fax:401-941-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
RI20121223G0001X
RI23671223G0001X
RI15911223G0001X
RI20111223G0001X
RI28251223G0001X
RI24961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPD00610OtherMEDICAL ASSISTANCE
RI8444-8OtherBLUE CROSS DENTAL