Provider Demographics
NPI:1598846651
Name:RAHIMI, MAMAL REZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAMAL
Middle Name:REZA
Last Name:RAHIMI
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 1:700 W PARR AVE STE J
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1416
Mailing Address - Country:US
Mailing Address - Phone:408-374-3633
Mailing Address - Fax:408-374-8934
Practice Address - Street 1:700 W PARR AVE STE J
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1416
Practice Address - Country:US
Practice Address - Phone:408-374-3633
Practice Address - Fax:408-374-8934
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist