Provider Demographics
NPI:1932290806
Name:GIRGIS, BAKHOUM (DMD)
Entity Type:Individual
Prefix:DR
First Name:BAKHOUM
Middle Name:
Last Name:GIRGIS
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 1:1 THURBER BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-1826
Mailing Address - Country:US
Mailing Address - Phone:401-231-7390
Mailing Address - Fax:401-232-1417
Practice Address - Street 1:1 THURBER BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-1826
Practice Address - Country:US
Practice Address - Phone:401-231-7390
Practice Address - Fax:401-232-1417
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI026631223G0001X
MA194941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice