Provider Demographics
NPI:1306104252
Name:BAGHAEI, MAHNAZ (DMD)
Entity type:Individual
Prefix:MS
First Name:MAHNAZ
Middle Name:
Last Name:BAGHAEI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 1ST ST
Mailing Address - Street 2:2J
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-8802
Mailing Address - Country:US
Mailing Address - Phone:251-767-6786
Mailing Address - Fax:
Practice Address - Street 1:240 W 116TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2431
Practice Address - Country:US
Practice Address - Phone:251-767-6786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-29
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
NY056900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program