Provider Demographics
NPI:1033600234
Name:MEHRANFAR, NINA (DMD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:MEHRANFAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34111 MILTON ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2277
Mailing Address - Country:US
Mailing Address - Phone:510-677-6628
Mailing Address - Fax:
Practice Address - Street 1:10918 W BELL RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1018
Practice Address - Country:US
Practice Address - Phone:623-688-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDOO99841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice