Individual
DR. BEHNAM FAKHRAVAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
322 SE 192ND AVE STE 100, VANCOUVER, WA 98683-9679
(219) 360-9587
Mailing address
322 SE 192ND AVE STE 100, VANCOUVER, WA 98683-9679
(360) 219-9587
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
1001779
WI
1223P0300X
Periodontics
28573
TX
1223P0300X
Periodontics
D9565
OR
1223P0300X
Periodontics
DDS61887
CA
1223P0300X
Periodontics
Primary
DE60231686
WA
Other
Enumeration date
07/21/2011
Last updated
02/20/2020
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