Provider Demographics
NPI:1225141690
Name:ANOOSHAHR, BAHAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:BAHAR
Middle Name:
Last Name:ANOOSHAHR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PARMENTER RD
Mailing Address - Street 2:UNIT A2
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3280
Mailing Address - Country:US
Mailing Address - Phone:603-437-7600
Mailing Address - Fax:603-437-8076
Practice Address - Street 1:12 PARMENTER RD
Practice Address - Street 2:UNIT A2
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3280
Practice Address - Country:US
Practice Address - Phone:603-437-7600
Practice Address - Fax:603-437-8076
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH34221223S0112X
MA211071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHANRE8038Medicare ID - Type Unspecified
T57552Medicare UPIN