Provider Demographics
NPI:1225175003
Name:MOHSENI, AMIR SHAHAB (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMIR SHAHAB
Middle Name:
Last Name:MOHSENI
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 1:25431 CABOT RD
Mailing Address - Street 2:#205
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5518
Mailing Address - Country:US
Mailing Address - Phone:949-597-0020
Mailing Address - Fax:949-597-1993
Practice Address - Street 1:25431 CABOT RD
Practice Address - Street 2:#205
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5518
Practice Address - Country:US
Practice Address - Phone:949-597-0020
Practice Address - Fax:949-597-1993
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449471223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics