Provider Demographics
NPI:1831498757
Name:MAHOOTY, MAHASTY
Entity Type:Individual
Prefix:MS
First Name:MAHASTY
Middle Name:
Last Name:MAHOOTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 VIA PAUSA
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-4905
Mailing Address - Country:US
Mailing Address - Phone:949-291-7078
Mailing Address - Fax:
Practice Address - Street 1:57 VIA PAUSA
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-4905
Practice Address - Country:US
Practice Address - Phone:949-291-7078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23000124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist