Provider Demographics
NPI:1093850695
Name:FAKHERI, MEHRAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:MEHRAN
Middle Name:
Last Name:FAKHERI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9722 LAUREL CANYON BLV
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331
Mailing Address - Country:US
Mailing Address - Phone:310-770-0165
Mailing Address - Fax:
Practice Address - Street 1:9722 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-4106
Practice Address - Country:US
Practice Address - Phone:310-770-0165
Practice Address - Fax:818-834-1064
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist