Active NPI
Bahar Houshmand
- Pediatric Dentistry
- Brookline, MA
National Provider Identifier
1013395359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN14212944
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170710001797 | CT | Order and Referring Only - Dentist | 1355610270 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN14212944 | MA | MD | Pediatric Dentist |
Interoperability endpoints
- 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.