=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881180867
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA BAHMANYAR DDS, MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2018
-----------------------------------------------------
Last Update Date | 06/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2903 N FM 1417
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75092-3424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-868-1370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 COOLIDGE CT
-----------------------------------------------------
City | CELINA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75009-4041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-588-6008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 34360
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 34360
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------