Provider Demographics
NPI:1619589629
Name:IRANMEHR, BAHAR (DDS)
Entity type:Individual
Prefix:
First Name:BAHAR
Middle Name:
Last Name:IRANMEHR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17390 PRESTON RD STE 242
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5781
Mailing Address - Country:US
Mailing Address - Phone:972-447-9707
Mailing Address - Fax:972-447-9779
Practice Address - Street 1:17390 PRESTON RD STE 242
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5781
Practice Address - Country:US
Practice Address - Phone:972-447-9707
Practice Address - Fax:972-447-9779
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice