Provider Demographics
NPI:1437439163
Name:ROUHANI, BAHAR (DDS)
Entity Type:Individual
Prefix:
First Name:BAHAR
Middle Name:
Last Name:ROUHANI
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 1:3707 AUDLEY ST
Mailing Address - Street 2:APT 12207
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3036
Mailing Address - Country:US
Mailing Address - Phone:213-905-1072
Mailing Address - Fax:281-272-0107
Practice Address - Street 1:13420 STATE HIGHWAY 249
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-3167
Practice Address - Country:US
Practice Address - Phone:281-272-0106
Practice Address - Fax:281-272-0107
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276671223G0001X
CA60798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice