Provider Demographics
NPI:1083250468
Name:MAHSA ESFANDIARI, D.D.S., DENTAL CORP.
Entity Type:Organization
Organization Name:MAHSA ESFANDIARI, D.D.S., DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESFANDIARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-477-0674
Mailing Address - Street 1:1706 MOROCCO DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5823
Mailing Address - Country:US
Mailing Address - Phone:408-477-0674
Mailing Address - Fax:
Practice Address - Street 1:14465 S BASCOM AVE STE K
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2002
Practice Address - Country:US
Practice Address - Phone:408-477-0674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty