Provider Demographics
NPI:1013395359
Name:HOUSHMAND, BAHAR
Entity Type:Individual
Prefix:
First Name:BAHAR
Middle Name:
Last Name:HOUSHMAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3312
Mailing Address - Country:US
Mailing Address - Phone:206-225-8629
Mailing Address - Fax:
Practice Address - Street 1:209 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5071
Practice Address - Country:US
Practice Address - Phone:617-870-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT118081223P0221X
390200000X
MADN142129441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program