Provider Demographics
NPI:1649538596
Name:BHATTARAI KOIRALA, BIBEKA (DMD)
Entity type:Individual
Prefix:MS
First Name:BIBEKA
Middle Name:
Last Name:BHATTARAI KOIRALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:BIBEKA
Other - Middle Name:
Other - Last Name:KOIRALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3310 BAINBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2856
Mailing Address - Country:US
Mailing Address - Phone:718-654-3456
Mailing Address - Fax:
Practice Address - Street 1:3310 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2856
Practice Address - Country:US
Practice Address - Phone:718-654-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0569731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program