Provider Demographics
NPI:1366558900
Name:DASS, BHAGWAN (DDS)
Entity type:Individual
Prefix:
First Name:BHAGWAN
Middle Name:
Last Name:DASS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1758
Mailing Address - Country:US
Mailing Address - Phone:585-247-0975
Mailing Address - Fax:585-247-6836
Practice Address - Street 1:653 HOWARD RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1758
Practice Address - Country:US
Practice Address - Phone:585-247-0975
Practice Address - Fax:585-247-6836
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0320241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY116727OtherUCCI TRI-CARE