Basic Information
| Provider Information | |||||||||
| NPI: | 1124530498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BACHANI | ||||||||
| FirstName: | SIRAJ | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4136 W 132ND ST | ||||||||
| Address2: | |||||||||
| City: | SAVAGE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553781625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525640445 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11231 AQUILA DR N | ||||||||
| Address2: | |||||||||
| City: | CHAMPLIN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553162096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632751318 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2017 | ||||||||
| LastUpdateDate: | 10/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D13923 | MN | Y | Dental Providers | Dentist |
No ID Information.