Provider Demographics
NPI:1326219221
Name:BEHNAZ BAGHERI D.D.S. PC
Entity Type:Organization
Organization Name:BEHNAZ BAGHERI D.D.S. PC
Other - Org Name:FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-788-1200
Mailing Address - Street 1:300 FREDERICK RD
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4665
Mailing Address - Country:US
Mailing Address - Phone:410-788-1200
Mailing Address - Fax:443-830-1495
Practice Address - Street 1:300 FREDERICK RD
Practice Address - Street 2:SUITE # 101
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4665
Practice Address - Country:US
Practice Address - Phone:410-788-1200
Practice Address - Fax:443-830-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13702261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental