Provider Demographics
NPI:1558705574
Name:BOUZ, MAHA MOURANI (DDS)
Entity Type:Individual
Prefix:
First Name:MAHA
Middle Name:MOURANI
Last Name:BOUZ
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 1:428 CANNON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3645
Mailing Address - Country:US
Mailing Address - Phone:626-255-0533
Mailing Address - Fax:909-592-5589
Practice Address - Street 1:428 CANNON AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3645
Practice Address - Country:US
Practice Address - Phone:626-255-0533
Practice Address - Fax:909-592-5589
Is Sole Proprietor?:No
Enumeration Date:2013-04-21
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist