Provider Demographics
NPI:1104944271
Name:BAHADORI, SHEILA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:BAHADORI
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 1:545 ISLAND ROAD
Mailing Address - Street 2:#1A
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1812
Mailing Address - Country:US
Mailing Address - Phone:201-818-6565
Mailing Address - Fax:
Practice Address - Street 1:545 ISLAND RD
Practice Address - Street 2:#1A
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2813
Practice Address - Country:US
Practice Address - Phone:201-818-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019281001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics