Provider Demographics
NPI:1245116078
Name:BAHADOR, AMIR REZA (DMD)
Entity type:Individual
Prefix:
First Name:AMIR REZA
Middle Name:
Last Name:BAHADOR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 N PARHAM RD STE 210
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4422
Mailing Address - Country:US
Mailing Address - Phone:804-635-3945
Mailing Address - Fax:
Practice Address - Street 1:2810 N PARHAM RD STE 210
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4422
Practice Address - Country:US
Practice Address - Phone:804-635-3945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014196731223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics