Provider Demographics
NPI:1164874087
Name:BAHRAMIAN, NAGHMEH
Entity Type:Individual
Prefix:
First Name:NAGHMEH
Middle Name:
Last Name:BAHRAMIAN
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 1:7911 WESTPARK DR APT 1528
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4292
Mailing Address - Country:US
Mailing Address - Phone:770-656-1124
Mailing Address - Fax:
Practice Address - Street 1:3116 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2639
Practice Address - Country:US
Practice Address - Phone:703-745-5496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-02
Last Update Date:2020-01-30
Deactivation Date:2018-07-18
Deactivation Code:
Reactivation Date:2019-09-18
Provider Licenses
StateLicense IDTaxonomies
VA0401415629122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentistGroup - Single Specialty