Provider Demographics
NPI:1366597783
Name:BAHADORI, AMIR H (DDS)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:H
Last Name:BAHADORI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 HAROLD ST
Mailing Address - Street 2:# 137
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-1044
Mailing Address - Country:US
Mailing Address - Phone:559-393-9174
Mailing Address - Fax:
Practice Address - Street 1:445 11TH ST
Practice Address - Street 2:
Practice Address - City:ORANGE COVE
Practice Address - State:CA
Practice Address - Zip Code:93646-2211
Practice Address - Country:US
Practice Address - Phone:559-646-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS55140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist