Provider Demographics
NPI:1306036512
Name:SAGHIZADEH, MAHASTI (DDS)
Entity Type:Individual
Prefix:
First Name:MAHASTI
Middle Name:
Last Name:SAGHIZADEH
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 1:1788 OAK CREEK DR
Mailing Address - Street 2:207
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2156
Mailing Address - Country:US
Mailing Address - Phone:415-385-7460
Mailing Address - Fax:
Practice Address - Street 1:1500 SOUTHGATE AVE
Practice Address - Street 2:208
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2259
Practice Address - Country:US
Practice Address - Phone:650-756-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444391223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics