Provider Demographics
NPI:1255063038
Name:CHAHBANDAR, ABDULRAHMAN
Entity type:Individual
Prefix:
First Name:ABDULRAHMAN
Middle Name:
Last Name:CHAHBANDAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12603 RAIN FOREST ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1382
Mailing Address - Country:US
Mailing Address - Phone:813-451-1432
Mailing Address - Fax:
Practice Address - Street 1:1395 CENTER DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-1213
Practice Address - Country:US
Practice Address - Phone:352-273-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0269241223G0001X
FLDN27020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice