Provider Demographics
NPI:1740594175
Name:MAHDAVI, ELHAM (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ELHAM
Middle Name:
Last Name:MAHDAVI
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 1:1516 VISTA CLUB CIR
Mailing Address - Street 2:#301
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-3741
Mailing Address - Country:US
Mailing Address - Phone:310-403-2494
Mailing Address - Fax:
Practice Address - Street 1:1516 VISTA CLUB CIR
Practice Address - Street 2:#301
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-3741
Practice Address - Country:US
Practice Address - Phone:310-403-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist