Provider Demographics
NPI:1871810473
Name:CHAGANI, BAHAREH (DMD)
Entity type:Individual
Prefix:DR
First Name:BAHAREH
Middle Name:
Last Name:CHAGANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:BAHAREH
Other - Middle Name:
Other - Last Name:CHAGANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2801 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-4008
Mailing Address - Country:US
Mailing Address - Phone:414-288-7388
Mailing Address - Fax:
Practice Address - Street 1:1801 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2186
Practice Address - Country:US
Practice Address - Phone:617-595-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6599-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist