Provider Demographics
NPI:1134357627
Name:ESMAILI, BAHAR (DDS)
Entity type:Individual
Prefix:DR
First Name:BAHAR
Middle Name:
Last Name:ESMAILI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BAHAREH
Other - Middle Name:ESMAEILI
Other - Last Name:MIRSHAHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1200 28TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1756
Mailing Address - Country:US
Mailing Address - Phone:303-417-1644
Mailing Address - Fax:303-417-1790
Practice Address - Street 1:1200 28TH ST STE 300
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1756
Practice Address - Country:US
Practice Address - Phone:303-417-1644
Practice Address - Fax:303-417-1790
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice