Provider Demographics
NPI:1265745681
Name:SANIKHATAM, BAHMAN (DMD)
Entity type:Individual
Prefix:DR
First Name:BAHMAN
Middle Name:
Last Name:SANIKHATAM
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 1:125 W CITY AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3103
Mailing Address - Country:US
Mailing Address - Phone:610-667-7171
Mailing Address - Fax:610-667-5121
Practice Address - Street 1:125 W CITY AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3103
Practice Address - Country:US
Practice Address - Phone:610-667-7171
Practice Address - Fax:610-667-5121
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024444L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice