Provider Demographics
NPI:1710194964
Name:MEHRVARZI, MEHRDOKHT (DDS)
Entity Type:Individual
Prefix:
First Name:MEHRDOKHT
Middle Name:
Last Name:MEHRVARZI
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 1:31952 CAMINO CAPISTRANO
Mailing Address - Street 2:STE C14 & C16
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675
Mailing Address - Country:US
Mailing Address - Phone:949-240-6888
Mailing Address - Fax:949-240-7653
Practice Address - Street 1:31952 CAMINO CAPISTRANO
Practice Address - Street 2:STE C14 & C16
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675
Practice Address - Country:US
Practice Address - Phone:949-240-6888
Practice Address - Fax:949-240-7653
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist