Provider Demographics
NPI:1740772524
Name:FERRAS MASHTOUB, DDS INC.
Entity Type:Organization
Organization Name:FERRAS MASHTOUB, DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHTOUB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-654-6136
Mailing Address - Street 1:19231 VICTORY BLVD STE 352
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6352
Mailing Address - Country:US
Mailing Address - Phone:818-378-5938
Mailing Address - Fax:
Practice Address - Street 1:19231 VICTORY BLVD STE 352
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6352
Practice Address - Country:US
Practice Address - Phone:818-378-5938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty