Siraj M. Bachani, DMD
Individual provider Active NPI Dentist · Champlin, MN
NPI 1124530498 · NPPES record last updated Oct 26, 2017
Key facts
- NPI
- 1124530498
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D13923 (MN)
- Practice address
- 11231 Aquila Dr N
Champlin, MN 55316-2096 - Phone
- (763) 275-1318
- NPI assigned
- Oct 26, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D13923 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Champlin Dentistry, PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D13923 | MN | Yes |
Addresses
Primary practice location
11231 Aquila Dr N
Champlin, MN 55316-2096
Mailing address
4136 W 132ND St
Savage, MN 55378-1625
Phone (952) 564-0445
Other providers in Champlin, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.