Provider Demographics
NPI:1902044241
Name:BEHMANESH, SARA
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:BEHMANESH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N CHARLES ST APT 1610
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4091
Mailing Address - Country:US
Mailing Address - Phone:301-704-2874
Mailing Address - Fax:
Practice Address - Street 1:1750 ROCKVILLE PIKE STE 10
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1658
Practice Address - Country:US
Practice Address - Phone:301-770-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-24
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist