Provider Demographics
NPI:1215465901
Name:BABADZHANOV, DANIEL (DMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BABADZHANOV
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 1:9931 64TH AVE APT B15
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2658
Mailing Address - Country:US
Mailing Address - Phone:631-552-6324
Mailing Address - Fax:
Practice Address - Street 1:511 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2246
Practice Address - Country:US
Practice Address - Phone:718-416-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT119501223G0001X
NY0600921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice