Provider Demographics
NPI:1881857126
Name:MAZHARI-KHORSHIDIAN, ANOOSHEH (DDS)
Entity Type:Individual
Prefix:
First Name:ANOOSHEH
Middle Name:
Last Name:MAZHARI-KHORSHIDIAN
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 1:4968 BOOTH CIR STE 109
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3370
Mailing Address - Country:US
Mailing Address - Phone:949-825-5354
Mailing Address - Fax:
Practice Address - Street 1:4968 BOOTH CIR STE 109
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3370
Practice Address - Country:US
Practice Address - Phone:949-825-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010198361223G0001X
CA591421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice