Provider Demographics
NPI:1154442424
Name:GORGANI, MAHNAZ (DMD)
Entity Type:Individual
Prefix:
First Name:MAHNAZ
Middle Name:
Last Name:GORGANI
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 1:10393 TORRE AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014
Mailing Address - Country:US
Mailing Address - Phone:408-496-4353
Mailing Address - Fax:
Practice Address - Street 1:10393 TORRE AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3235
Practice Address - Country:US
Practice Address - Phone:408-446-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist