Provider Demographics
NPI:1376852970
Name:JABERIANSARI, MAHSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHSA
Middle Name:
Last Name:JABERIANSARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MAHSA
Other - Middle Name:
Other - Last Name:ANSARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1 KENNETH DR
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-1600
Mailing Address - Country:US
Mailing Address - Phone:415-730-7162
Mailing Address - Fax:
Practice Address - Street 1:2089 VALE RD
Practice Address - Street 2:SUITE 15 AND 16
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3847
Practice Address - Country:US
Practice Address - Phone:415-746-9412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice