Provider Demographics
NPI:1396833042
Name:BAYAT, MAHBOOBEH (DDS)
Entity Type:Individual
Prefix:
First Name:MAHBOOBEH
Middle Name:
Last Name:BAYAT
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 1:2100 W NORTHWEST HWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7808
Mailing Address - Country:US
Mailing Address - Phone:817-329-6000
Mailing Address - Fax:817-251-1833
Practice Address - Street 1:2100 W NORTHWEST HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7808
Practice Address - Country:US
Practice Address - Phone:817-329-6000
Practice Address - Fax:817-251-1833
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice