Provider Demographics
NPI:1578990099
Name:MEHRANPOUR, NAVID (DDS)
Entity Type:Individual
Prefix:
First Name:NAVID
Middle Name:
Last Name:MEHRANPOUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 N TEXAS ST STE 311
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5623
Mailing Address - Country:US
Mailing Address - Phone:707-422-2410
Mailing Address - Fax:
Practice Address - Street 1:1545 N TEXAS ST STE 311
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5623
Practice Address - Country:US
Practice Address - Phone:707-422-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-29
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist