Provider Demographics
NPI:1811709900
Name:BEHNAZ BAGHERI DDS PC
Entity type:Organization
Organization Name:BEHNAZ BAGHERI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JALALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-917-3013
Mailing Address - Street 1:5072 DORSEY HALL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7845
Mailing Address - Country:US
Mailing Address - Phone:410-772-1200
Mailing Address - Fax:
Practice Address - Street 1:5072 DORSEY HALL DR STE 102
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7845
Practice Address - Country:US
Practice Address - Phone:410-772-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHNAZ BAGHERI DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental