Provider Demographics
NPI:1275665192
Name:MAHINE MAHAJERI DDS PC
Entity Type:Organization
Organization Name:MAHINE MAHAJERI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAJERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:313-584-6530
Mailing Address - Street 1:6325 CHASE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126
Mailing Address - Country:US
Mailing Address - Phone:313-584-6530
Mailing Address - Fax:313-357-6531
Practice Address - Street 1:6325 CHASE RD
Practice Address - Street 2:SUITE A
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-584-6530
Practice Address - Fax:313-357-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty