Individual provider Active NPI

Bahar Houshmand

  • Pediatric Dentistry
  • Brookline, MA
National Provider Identifier
1013395359
Registry record updated Mar 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN14212944 Issued in MA
Practice address
209 Harvard St
Brookline, MA 02446-5071
Phone
(617) 870-6511
NPI assigned
May 6, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 11808 CT
Student in an Organized Health Care Education/Training Program 390200000X
Pediatric Dentistry 1223P0221X DN14212944 MA Primary

Addresses

Primary practice location

209 Harvard St
Brookline, MA 02446-5071

Mailing address

108 Greenwood Rd
Andover, MA 01810-3312
Phone (206) 225-8629

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170710001797 CT Order and Referring Only - DentistPractitioner - Dentist 1355610270

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN14212944MAMDPediatric Dentist

Interoperability endpoints

  • Direct secure messaging: bhoushmand16895@connecticutchildrens.direct-ci.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1013395359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 GREENWOOD RD",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018103312",
            "telephone_number": "206-225-8629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 HARVARD ST",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024465071",
            "telephone_number": "617-870-6511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOUSHMAND",
        "first_name": "BAHAR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-06",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CT",
            "license": "11808",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "DN14212944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookline, MA

Sources for this page

Verify at the official NPI Registry.