Provider Demographics
NPI:1114208022
Name:BEHBAHANI, BABAK
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:BEHBAHANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 E MOLLY LN
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-6682
Mailing Address - Country:US
Mailing Address - Phone:602-741-2355
Mailing Address - Fax:
Practice Address - Street 1:4537 E MOLLY LN
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-6682
Practice Address - Country:US
Practice Address - Phone:602-741-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008263122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist