Provider Demographics
NPI:1104059690
Name:BEHMANESH, SARAH BAHAR (DDS)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:BAHAR
Last Name:BEHMANESH
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 1:22800 BULVERDE RD APT 4201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-3075
Mailing Address - Country:US
Mailing Address - Phone:617-784-9197
Mailing Address - Fax:
Practice Address - Street 1:1711 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-4615
Practice Address - Country:US
Practice Address - Phone:617-784-9197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25213122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist