Provider Demographics
NPI:1275590788
Name:HASHEMIAN, MANSOOREH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANSOOREH
Middle Name:
Last Name:HASHEMIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MASI
Other - Middle Name:
Other - Last Name:HASHEMIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2981 MICHELSON DR
Mailing Address - Street 2:#B
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-0659
Mailing Address - Country:US
Mailing Address - Phone:949-251-0011
Mailing Address - Fax:949-251-0085
Practice Address - Street 1:2981 MICHELSON DR
Practice Address - Street 2:#B
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-0659
Practice Address - Country:US
Practice Address - Phone:949-251-0011
Practice Address - Fax:949-251-0085
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice