Provider Demographics
NPI:1871945840
Name:SEIHOUN, BABAK
Entity type:Individual
Prefix:
First Name:BABAK
Middle Name:
Last Name:SEIHOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12070 OLD LINE CTR STE 101
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2503
Mailing Address - Country:US
Mailing Address - Phone:301-645-8530
Mailing Address - Fax:301-843-8570
Practice Address - Street 1:12070 OLD LINE CTR STE 101
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2503
Practice Address - Country:US
Practice Address - Phone:413-221-4979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415271122300000X
MD16140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist