Provider Demographics
NPI:1740349687
Name:BARAKHSHAN, HAMIDREZA (DDS)
Entity type:Individual
Prefix:DR
First Name:HAMIDREZA
Middle Name:
Last Name:BARAKHSHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 WHEATON WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3605
Mailing Address - Country:US
Mailing Address - Phone:360-373-3487
Mailing Address - Fax:360-373-3799
Practice Address - Street 1:4207 WHEATON WAY
Practice Address - Street 2:SUITE C
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3605
Practice Address - Country:US
Practice Address - Phone:360-373-3487
Practice Address - Fax:360-373-3799
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000092571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice