Provider Demographics
NPI:1396897237
Name:BAGHERI, BEHNAZ (DDS)
Entity type:Individual
Prefix:DR
First Name:BEHNAZ
Middle Name:
Last Name:BAGHERI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FREDERICK ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-788-1200
Mailing Address - Fax:443-830-1495
Practice Address - Street 1:300 FREDERICK ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-788-1200
Practice Address - Fax:443-830-1495
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13702122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice