Provider Demographics
NPI:1407063720
Name:MAGHSOUDY, FERESHTEH
Entity Type:Individual
Prefix:
First Name:FERESHTEH
Middle Name:
Last Name:MAGHSOUDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DR STE B207
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1725
Mailing Address - Country:US
Mailing Address - Phone:858-558-3490
Mailing Address - Fax:858-558-3188
Practice Address - Street 1:8950 VILLA LA JOLLA DRIVE #B207
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-558-3490
Practice Address - Fax:858-558-3188
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice