Provider Demographics
NPI:1497765713
Name:MASHOOF, DANIEL GHORBANI (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GHORBANI
Last Name:MASHOOF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:HAMID
Other - Middle Name:REZA
Other - Last Name:GHORBANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:12821 MAIN ST STE 150
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-9130
Mailing Address - Country:US
Mailing Address - Phone:425-213-6606
Mailing Address - Fax:425-643-3733
Practice Address - Street 1:12821 MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-9130
Practice Address - Country:US
Practice Address - Phone:760-947-9853
Practice Address - Fax:760-956-7813
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000097701223P0700X
CADDS60273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5045851Medicaid