Provider Demographics
NPI:1205319977
Name:BAHAR, MUDHER RAFID (DMD)
Entity type:Individual
Prefix:
First Name:MUDHER
Middle Name:RAFID
Last Name:BAHAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12231 WATER ELM LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-9071
Mailing Address - Country:US
Mailing Address - Phone:703-949-8474
Mailing Address - Fax:
Practice Address - Street 1:609 E MAIN ST STE P
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3182
Practice Address - Country:US
Practice Address - Phone:540-900-0970
Practice Address - Fax:540-767-5227
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014174271223E0200X
PADS0419571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice