Provider Demographics
NPI:1760628432
Name:CHITGAR, MEHRAN MARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEHRAN
Middle Name:MARY
Last Name:CHITGAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MEHRAN
Other - Middle Name:
Other - Last Name:CHITGAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:10185 PARKWOOD DRIV#9
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014
Mailing Address - Country:US
Mailing Address - Phone:650-823-1667
Mailing Address - Fax:
Practice Address - Street 1:570 EL CAMINO REAL STE 130
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1248
Practice Address - Country:US
Practice Address - Phone:650-823-1667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist