Provider Demographics
NPI:1912165622
Name:BIGDELI, JAVAD (DDS MS)
Entity type:Individual
Prefix:
First Name:JAVAD
Middle Name:
Last Name:BIGDELI
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:EZATTOLLAH
Other - Middle Name:
Other - Last Name:BIGDELI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 SOUTH CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523
Mailing Address - Country:US
Mailing Address - Phone:914-592-4416
Mailing Address - Fax:914-592-0908
Practice Address - Street 1:160 SOUTH CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523
Practice Address - Country:US
Practice Address - Phone:914-592-4416
Practice Address - Fax:914-592-0908
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038676204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery