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General NPI Number Information
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NPI Number | 1376796854
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Entity Type | Individual
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Provider Name | BAHARAK BAHRAMI DDS
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Gender | Female
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 8230 BOONE BLVD STE 100
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City | VIENNA
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State | VA
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Zip | 22182-2647
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Country | US
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Telephone | 703-790-0800
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Fax | 703-790-0880
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Provider Business Mailing Address
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Address Line | 8230 BOONE BLVD STE 100
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City | VIENNA
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State | VA
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Zip | 22182-2647
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Country | US
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Telephone | 703-790-0800
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Fax | 703-790-0880
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0401412315
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License Number State | VA
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