Provider Demographics
NPI:1922587484
Name:RAHBAR, SIAVASH K (DMD)
Entity Type:Individual
Prefix:DR
First Name:SIAVASH
Middle Name:K
Last Name:RAHBAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 AUTUMN RUN LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-5033
Mailing Address - Country:US
Mailing Address - Phone:832-512-0340
Mailing Address - Fax:
Practice Address - Street 1:1450 W CAMERON AVE
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2641
Practice Address - Country:US
Practice Address - Phone:512-409-2883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0418931223G0001X
TX363371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice