Provider Demographics
NPI:1538518535
Name:MOHSENI BEHBAHANI, SHIMA (DMD)
Entity Type:Individual
Prefix:
First Name:SHIMA
Middle Name:
Last Name:MOHSENI BEHBAHANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 S MINGO RD APT 3307
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 SUNDANCE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-7917
Practice Address - Country:US
Practice Address - Phone:512-733-6832
Practice Address - Fax:512-733-6832
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist