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NPI Code Detail

MEDICARE: DR. AMIR H BAHADORI D.D.S

MEDICARE: DR. AMIR H BAHADORI D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDDS55140CA

General Provider Information

NPI Number : 1366597783
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMIR H BAHADORI D.D.S
Provider Business Mailing Address
First Line : 901 HAROLD ST
Second Line : # 137
City : KINGSBURG
State : CA
Zip : 93631-1044
Country : US
Telephone Number : 559-393-9174
Fax Number :
Provider Business Practice Location Address
First Line : 445 11TH ST
Second Line :
City : ORANGE COVE
State : CA
Zip : 93646-2211
Country : US
Telephone Number : 559-646-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/08/2007

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