Provider Demographics
NPI:1124194469
Name:MESBAH, RAHIM (DDS)
Entity Type:Individual
Prefix:MR
First Name:RAHIM
Middle Name:
Last Name:MESBAH
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 1:1101 STANDIFORD AVE
Mailing Address - Street 2:STE D3
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-571-3740
Mailing Address - Fax:209-571-3740
Practice Address - Street 1:1101 STANDIFORD AVE
Practice Address - Street 2:STE D3
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-571-3740
Practice Address - Fax:209-571-3740
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist