Provider Demographics
NPI:1376796854
Name:BAHRAMI, BAHARAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BAHARAK
Middle Name:
Last Name:BAHRAMI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 BOONE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2647
Mailing Address - Country:US
Mailing Address - Phone:703-790-0800
Mailing Address - Fax:703-790-0880
Practice Address - Street 1:8230 BOONE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2647
Practice Address - Country:US
Practice Address - Phone:703-790-0800
Practice Address - Fax:703-790-0880
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist