Individual
DR. ARMIN BOUTEHSAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1253 W PRATT ST, BALTIMORE, MD 21223-2684
(410) 727-4746
(410) 727-6767
Mailing address
2221 E BIJOU ST STE 100, COLORADO SPRINGS, CO 80909-8009
(719) 576-1850
(719) 955-3470
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
16564
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
767008700
—
MD
01
—
965375292
ADA
—
Enumeration date
07/05/2018
Last updated
09/18/2019
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