Provider Demographics
NPI:1245595222
Name:BAHRAMNEJAD, ARGHAVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ARGHAVAN
Middle Name:
Last Name:BAHRAMNEJAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ARGHAVAN
Other - Middle Name:
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1321 NW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2139
Mailing Address - Country:US
Mailing Address - Phone:772-343-0179
Mailing Address - Fax:
Practice Address - Street 1:1321 NW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2139
Practice Address - Country:US
Practice Address - Phone:772-343-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN199491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics