MEDICARE: BAHAR ROUHANI DDS

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
1	1223G0001X	General Practice Dentistry	27667	TX
2	122300000X	Dentist	60798	CA

General Provider Information

NPI Number	:	1437439163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAHAR ROUHANI DDS

Provider Business Mailing Address
First Line	:	3707 AUDLEY ST
Second Line	:	APT 12207
City	:	HOUSTON
State	:	TX
Zip	:	77098-3036
Country	:	US
Telephone Number	:	213-905-1072
Fax Number	:	281-272-0107

Provider Business Practice Location Address
First Line	:	13420 STATE HIGHWAY 249
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77086-3167
Country	:	US
Telephone Number	:	281-272-0106
Fax Number	:	281-272-0107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	02/09/2012

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