Provider Demographics
NPI:1467001891
Name:BAHADORZADEH, SHOKOOH (DDS)
Entity Type:Individual
Prefix:
First Name:SHOKOOH
Middle Name:
Last Name:BAHADORZADEH
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 1:2940 PAYSON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2032
Mailing Address - Country:US
Mailing Address - Phone:409-730-3837
Mailing Address - Fax:
Practice Address - Street 1:14270 FM 2100 RD
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-9151
Practice Address - Country:US
Practice Address - Phone:281-886-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX354761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice