Provider Demographics
NPI:1699907147
Name:ESHRAGHI, BAHRAM
Entity type:Individual
Prefix:
First Name:BAHRAM
Middle Name:
Last Name:ESHRAGHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 HARVARD ST NW STE 108
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3710
Mailing Address - Country:US
Mailing Address - Phone:202-462-5227
Mailing Address - Fax:202-462-7445
Practice Address - Street 1:1613 HARVARD ST NW STE 108
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3710
Practice Address - Country:US
Practice Address - Phone:202-462-5227
Practice Address - Fax:202-462-7445
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10008401223G0001X
VA04014125121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice