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General NPI Number Information
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NPI Number | 1053756205
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Entity Type | Individual
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Provider Name | BOBAK BAKHSHOUDEH
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Gender | Male
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 06/29/2019
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Provider Practice Location Address
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Address Line | 25 TUDOR CITY PL APT 2122
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City | NEW YORK
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State | NY
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Zip | 10017-6819
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Country | US
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Telephone | 631-880-2208
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Fax |
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Provider Business Mailing Address
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Address Line | 308 E 38TH ST APT 6D
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City | NEW YORK
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State | NY
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Zip | 10016-9821
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Country | US
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Telephone | 631-880-2208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 057492-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 057492-1
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License Number State | NY
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