Healthcare Provider Details

I. General information

NPI: 1609509934
Provider Name (Legal Business Name): BIHAC MAZIGH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 06/15/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 GRAND CONCOURSE FL 6
BRONX NY
10453-8202
US

IV. Provider business mailing address

1775 GRAND CONCOURSE FL 6
BRONX NY
10453-8202
US

V. Phone/Fax

Practice location:
  • Phone: 718-901-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number063539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: