Provider Demographics
NPI:1760632038
Name:MEHRAN A. RAZA D.D.S., INC.
Entity Type:Organization
Organization Name:MEHRAN A. RAZA D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-823-7002
Mailing Address - Street 1:10369 WESTWARD CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-6152
Mailing Address - Country:US
Mailing Address - Phone:619-823-7002
Mailing Address - Fax:760-747-4288
Practice Address - Street 1:910 E OHIO AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3438
Practice Address - Country:US
Practice Address - Phone:760-747-7223
Practice Address - Fax:760-747-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty