Provider Demographics
NPI:1407340334
Name:MOFARRAHI, MAHROO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAHROO
Middle Name:
Last Name:MOFARRAHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SHOWERS DRIVE, SAN ANTONIO DENTAL
Mailing Address - Street 2:SUITE #3
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040
Mailing Address - Country:US
Mailing Address - Phone:650-917-8348
Mailing Address - Fax:650-917-8349
Practice Address - Street 1:530 SHOWERS DRIVE, SAN ANTONIO DENTAL
Practice Address - Street 2:SUITE #3
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040
Practice Address - Country:US
Practice Address - Phone:650-917-8348
Practice Address - Fax:650-917-8349
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1042641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program