Provider Demographics
NPI:1689240632
Name:YOUSEFI, MEHRSHAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEHRSHAD
Middle Name:
Last Name:YOUSEFI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1588 SLASH PINE PL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8467
Mailing Address - Country:US
Mailing Address - Phone:407-865-0987
Mailing Address - Fax:
Practice Address - Street 1:2565 ENTERPRISE RD STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8016
Practice Address - Country:US
Practice Address - Phone:386-456-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist