Provider Demographics
NPI:1639144140
Name:BAGHAI, BEHZAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEHZAD
Middle Name:
Last Name:BAGHAI
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 1:3204 N MAIN ST # 121
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76106-5900
Mailing Address - Country:US
Mailing Address - Phone:817-624-6677
Mailing Address - Fax:817-624-6678
Practice Address - Street 1:3204 N MAIN ST # 121
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-5900
Practice Address - Country:US
Practice Address - Phone:817-624-6677
Practice Address - Fax:817-624-6678
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014110931223P0221X
TX236641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry