Provider Demographics
NPI:1902811318
Name:BAHLANI, VEDVYAS S (DMD)
Entity Type:Individual
Prefix:
First Name:VEDVYAS
Middle Name:S
Last Name:BAHLANI
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 1:17 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1023
Mailing Address - Country:US
Mailing Address - Phone:718-803-6300
Mailing Address - Fax:718-899-1717
Practice Address - Street 1:7517 41ST AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1004
Practice Address - Country:US
Practice Address - Phone:718-803-6300
Practice Address - Fax:718-899-1717
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0365081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice