Provider Demographics
NPI:1568663946
Name:AHRAR, MITRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITRA
Middle Name:
Last Name:AHRAR
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 1:25151 CHESHIRE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-2846
Mailing Address - Country:US
Mailing Address - Phone:651-335-3535
Mailing Address - Fax:
Practice Address - Street 1:5175 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 405
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3317
Practice Address - Country:US
Practice Address - Phone:562-999-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice