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General NPI Number Information
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NPI Number | 1073851960
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Entity Type | Organization
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Legal Business Name | EBRAHIM H. BARADARAN D.M.D. P.C.
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Dates
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Enumeration Date | 01/28/2013
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 297 MARKET ST. SUITE 2
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City | NEW CASTLE
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State | VA
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Zip | 24127
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Country | US
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Telephone | 540-864-5125
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Fax | 540-864-5377
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Provider Business Mailing Address
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Address Line | PO BOX 727
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City | NEW CASTLE
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State | VA
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Zip | 24127-0727
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Country | US
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Telephone | 540-864-5125
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Fax | 540-864-5377
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Authorized Official
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Title or Position | OWNER
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Name | DR. EBRAHIM H BARADARAN
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Credential | D.M.D
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Telephone | 804-651-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401410423
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License Number State | VA
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