Provider Demographics
NPI:1073851960
Name:EBRAHIM H. BARADARAN D.M.D. P.C.
Entity Type:Organization
Organization Name:EBRAHIM H. BARADARAN D.M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EBRAHIM
Authorized Official - Middle Name:H
Authorized Official - Last Name:BARADARAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-651-1515
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24127-0727
Mailing Address - Country:US
Mailing Address - Phone:540-864-5125
Mailing Address - Fax:540-864-5377
Practice Address - Street 1:297 MARKET ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW CASTLE
Practice Address - State:VA
Practice Address - Zip Code:24127
Practice Address - Country:US
Practice Address - Phone:540-864-5125
Practice Address - Fax:540-864-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty