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General NPI Number Information
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NPI Number | 1679769038
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Entity Type | Individual
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Provider Name | HAJIRA HUSAIN BIDGOLI DMD
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Gender | Female
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 2211 MERRICK RD
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City | MERRICK
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State | NY
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Zip | 11566-4752
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Country | US
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Telephone | 516-365-5439
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Fax |
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Provider Business Mailing Address
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Address Line | 10 WESTEDGE ST UNIT 727
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City | CHARLESTON
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State | SC
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Zip | 29403-6927
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Country | US
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Telephone | 215-370-1726
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 052384
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License Number State | NY
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