Provider Demographics
NPI:1316936651
Name:BIRGANI, BIJAN (DMD)
Entity type:Individual
Prefix:DR
First Name:BIJAN
Middle Name:
Last Name:BIRGANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:BIJAN
Other - Middle Name:
Other - Last Name:BIRGANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3464 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2404
Mailing Address - Country:US
Mailing Address - Phone:814-836-0757
Mailing Address - Fax:814-836-0787
Practice Address - Street 1:3464 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2404
Practice Address - Country:US
Practice Address - Phone:814-836-0757
Practice Address - Fax:881-483-6078
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
574094OtherUNITED CONCORDIA
PA1013659200OtherMEDPLUS
PA1013659200Medicaid