Provider Demographics
NPI:1477937639
Name:MAHMOUDI, BEHNAZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEHNAZ
Middle Name:
Last Name:MAHMOUDI
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 1:840 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-5312
Mailing Address - Country:US
Mailing Address - Phone:765-674-0854
Mailing Address - Fax:
Practice Address - Street 1:840 E 45TH ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5312
Practice Address - Country:US
Practice Address - Phone:765-674-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012354A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist