Provider Demographics
NPI:1730666918
Name:BAHRAMI, SHAHRAM (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAHRAM
Middle Name:
Last Name:BAHRAMI
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WOOTTON PARKWAY, SUITE 540
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-424-0088
Mailing Address - Fax:
Practice Address - Street 1:1101 WOOTTON PARKWAY, SUITE 540
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-424-0088
Practice Address - Fax:240-885-7806
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist