Provider Demographics
NPI:1447397260
Name:MAZAHERI, ENSIEH H (DDS)
Entity Type:Individual
Prefix:DR
First Name:ENSIEH
Middle Name:H
Last Name:MAZAHERI
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 1:929 N ORANGE GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3354
Mailing Address - Country:US
Mailing Address - Phone:626-449-3700
Mailing Address - Fax:
Practice Address - Street 1:929 N ORANGE GROVE BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3354
Practice Address - Country:US
Practice Address - Phone:626-449-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist