Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6652 | MD |
NPI | 1043604143 |
---|---|
Provider Name | Shahrzad Bahrami |
First Address | Germantown, MD 20876-1743 |
Second Address | Germantown, MD 20876-1743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 26/03/2015 |