Provider Demographics
NPI:1912901893
Name:GHAFOURI, BAHAR (DDS, MS, APC)
Entity Type:Individual
Prefix:
First Name:BAHAR
Middle Name:
Last Name:GHAFOURI
Suffix:
Gender:F
Credentials:DDS, MS, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OSBORN ST
Mailing Address - Street 2:STE 180
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4690
Mailing Address - Country:US
Mailing Address - Phone:949-786-7800
Mailing Address - Fax:949-786-3881
Practice Address - Street 1:2 OSBORN ST
Practice Address - Street 2:STE 180
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4690
Practice Address - Country:US
Practice Address - Phone:949-786-7800
Practice Address - Fax:949-786-3881
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
CA410801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics