Provider Demographics
NPI:1477823318
Name:BAHRI, GABY (DDS)
Entity Type:Individual
Prefix:
First Name:GABY
Middle Name:
Last Name:BAHRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8131 BAYMEADOWS CIR W
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2012
Mailing Address - Country:US
Mailing Address - Phone:904-448-9669
Mailing Address - Fax:904-448-9560
Practice Address - Street 1:8131 BAYMEADOWS CIR W
Practice Address - Street 2:SUITE 102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2012
Practice Address - Country:US
Practice Address - Phone:904-448-9669
Practice Address - Fax:904-448-9560
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN125891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics