Provider Demographics
NPI:1760492953
Name:MEHRABI, AMIR HOSSEIN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:HOSSEIN
Last Name:MEHRABI
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 BRECKENRIDGE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1558
Mailing Address - Country:US
Mailing Address - Phone:501-227-7949
Mailing Address - Fax:501-227-7763
Practice Address - Street 1:1225 BRECKENRIDGE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1558
Practice Address - Country:US
Practice Address - Phone:501-227-7949
Practice Address - Fax:501-227-7763
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70221223E0200X
AR31001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics