Provider Demographics
NPI:1851400816
Name:GOZINI, MAHNAZ DEBORAH (DDS)
Entity Type:Individual
Prefix:
First Name:MAHNAZ
Middle Name:DEBORAH
Last Name:GOZINI
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 1:18032 VENTURA BLVD
Mailing Address - Street 2:#2
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-881-1330
Mailing Address - Fax:818-881-3481
Practice Address - Street 1:18032 VENTURA BLVD
Practice Address - Street 2:#2
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:818-881-1330
Practice Address - Fax:818-881-3481
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3801601OtherMEDI CAL