Provider Demographics
NPI:1104715176
Name:MEHRAZAR, YASAMIN (DMD)
Entity type:Individual
Prefix:DR
First Name:YASAMIN
Middle Name:
Last Name:MEHRAZAR
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 1:1405 VILLETTE CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8904
Mailing Address - Country:US
Mailing Address - Phone:209-606-2552
Mailing Address - Fax:
Practice Address - Street 1:1008 6TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2209
Practice Address - Country:US
Practice Address - Phone:209-573-8880
Practice Address - Fax:209-573-8881
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1118481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice