Provider Demographics
NPI:1124530498
Name:BACHANI, SIRAJ M (DMD)
Entity type:Individual
Prefix:DR
First Name:SIRAJ
Middle Name:M
Last Name:BACHANI
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 1:4136 W 132ND ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-1625
Mailing Address - Country:US
Mailing Address - Phone:952-564-0445
Mailing Address - Fax:
Practice Address - Street 1:11231 AQUILA DR N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2096
Practice Address - Country:US
Practice Address - Phone:763-275-1318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist