Provider Demographics
NPI:1780892208
Name:BERENJI, HOMAYON (DDS DMD)
Entity type:Individual
Prefix:DR
First Name:HOMAYON
Middle Name:
Last Name:BERENJI
Suffix:
Gender:M
Credentials:DDS DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LOUIS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-2844
Mailing Address - Country:US
Mailing Address - Phone:267-991-9696
Mailing Address - Fax:
Practice Address - Street 1:600 LOUIS DR STE 105
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2844
Practice Address - Country:US
Practice Address - Phone:267-991-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036886122300000X, 1223E0200X
CA54635122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist