Provider Demographics
NPI:1538397187
Name:ANSARI, BAHAR (DMD)
Entity type:Individual
Prefix:DR
First Name:BAHAR
Middle Name:
Last Name:ANSARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HAMLET CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1804
Mailing Address - Country:US
Mailing Address - Phone:732-500-3433
Mailing Address - Fax:
Practice Address - Street 1:4 WALTER FORAN BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4664
Practice Address - Country:US
Practice Address - Phone:908-788-1661
Practice Address - Fax:908-284-0797
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023790001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice