Provider Demographics
NPI:1104942804
Name:BIHARY, JASON E (DMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:E
Last Name:BIHARY
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 1:1055 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1521
Mailing Address - Country:US
Mailing Address - Phone:814-684-3261
Mailing Address - Fax:814-684-3280
Practice Address - Street 1:1055 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1521
Practice Address - Country:US
Practice Address - Phone:814-684-3261
Practice Address - Fax:814-684-3280
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031657-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000563403OtherGRP ID# UCCI
PA001561470OtherPIN-UCCI
PA1295764868OtherGROUP NPI
PA001561470OtherPIN-UCCI