Provider Demographics
NPI:1679094866
Name:BAREKATAIN, AMIR S (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:S
Last Name:BAREKATAIN
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 1:300 N CHARLES ST STE D
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4305
Mailing Address - Country:US
Mailing Address - Phone:410-685-0002
Mailing Address - Fax:
Practice Address - Street 1:300 N CHARLES ST STE D
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4305
Practice Address - Country:US
Practice Address - Phone:410-685-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0401416233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program