Provider Demographics
NPI:1114319951
Name:AMANZADEH, BAHARAK (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:BAHARAK
Middle Name:
Last Name:AMANZADEH
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BROADWAY STE 500
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4033
Mailing Address - Country:US
Mailing Address - Phone:510-208-5911
Mailing Address - Fax:510-208-5933
Practice Address - Street 1:1000 BROADWAY STE 500
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4033
Practice Address - Country:US
Practice Address - Phone:510-208-5911
Practice Address - Fax:510-208-5933
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist