Provider Demographics
NPI:1558593178
Name:MEHRNAZ IRANI DMD,INC
Entity Type:Organization
Organization Name:MEHRNAZ IRANI DMD,INC
Other - Org Name:VISTA VILLAGE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:IRANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-414-7705
Mailing Address - Street 1:12463 RANCHO BERNARDO RD # 525
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2143
Mailing Address - Country:US
Mailing Address - Phone:858-414-7705
Mailing Address - Fax:
Practice Address - Street 1:950 ESCONDIDO AVE STE B
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5208
Practice Address - Country:US
Practice Address - Phone:760-208-4030
Practice Address - Fax:760-650-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-15
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty