Provider Demographics
NPI:1568633139
Name:NOSRATI-JAHROMI, MAHIN (DDS)
Entity Type:Individual
Prefix:
First Name:MAHIN
Middle Name:
Last Name:NOSRATI-JAHROMI
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 1:13677 FOOTHILL BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-0214
Mailing Address - Country:US
Mailing Address - Phone:909-827-6407
Mailing Address - Fax:909-330-2144
Practice Address - Street 1:13677 FOOTHILL BLVD STE M
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-0214
Practice Address - Country:US
Practice Address - Phone:909-330-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice