Provider Demographics
NPI:1326206533
Name:MOHSENZADEH, MARYAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:MOHSENZADEH
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 1:22 OLD COACH RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3857
Mailing Address - Country:US
Mailing Address - Phone:707-254-9872
Mailing Address - Fax:
Practice Address - Street 1:22 OLD COACH RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3857
Practice Address - Country:US
Practice Address - Phone:707-254-9872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist