Provider Demographics
NPI:1659404655
Name:KLEUSCH-MEKHTEYS, MASHA (DDS)
Entity Type:Individual
Prefix:
First Name:MASHA
Middle Name:
Last Name:KLEUSCH-MEKHTEYS
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 1:1860 EL CAMINO REAL STE 315
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3114
Mailing Address - Country:US
Mailing Address - Phone:650-692-0555
Mailing Address - Fax:650-692-6047
Practice Address - Street 1:1860 EL CAMINO REAL STE 315
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3114
Practice Address - Country:US
Practice Address - Phone:650-692-0555
Practice Address - Fax:650-692-6047
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice