Provider Demographics
NPI:1922085638
Name:BARANI, ELHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELHAM
Middle Name:
Last Name:BARANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELHAM
Other - Middle Name:
Other - Last Name:BOSAK-BARANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:101 BODIN CIR
Mailing Address - Street 2:60 MDG/SGDD
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIR
Practice Address - Street 2:60 MDG/SGDD
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1809
Practice Address - Country:US
Practice Address - Phone:707-423-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20783122300000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program