Provider Demographics
NPI:1154511392
Name:MAH, DEANNA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:
Last Name:MAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E ROMIE LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4210
Mailing Address - Country:US
Mailing Address - Phone:831-424-0881
Mailing Address - Fax:831-424-1026
Practice Address - Street 1:750 E ROMIE LN
Practice Address - Street 2:SUITE B
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4210
Practice Address - Country:US
Practice Address - Phone:831-424-0881
Practice Address - Fax:831-424-1026
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist