Provider Demographics
NPI:1821211798
Name:BAGHERPOUR, MAHNAZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHNAZ
Middle Name:
Last Name:BAGHERPOUR
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 1:11775 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2843
Mailing Address - Country:US
Mailing Address - Phone:310-444-1818
Mailing Address - Fax:310-444-3196
Practice Address - Street 1:11775 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2843
Practice Address - Country:US
Practice Address - Phone:310-444-1818
Practice Address - Fax:310-444-3196
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice