Provider Demographics
NPI:1417176231
Name:FESHARAKI, AMIR MANSOOR (DDS)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:MANSOOR
Last Name:FESHARAKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:SUITE 251
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1200
Mailing Address - Country:US
Mailing Address - Phone:818-837-8300
Mailing Address - Fax:818-837-8302
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:SUITE 251
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1200
Practice Address - Country:US
Practice Address - Phone:818-837-8300
Practice Address - Fax:818-837-8302
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379961223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics