Provider Demographics
NPI:1891905626
Name:EMAMISADR, MAHVASH II (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MAHVASH
Middle Name:
Last Name:EMAMISADR
Suffix:II
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 1:7902 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2937
Mailing Address - Country:US
Mailing Address - Phone:818-353-5520
Mailing Address - Fax:818-353-4387
Practice Address - Street 1:7902 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2937
Practice Address - Country:US
Practice Address - Phone:818-353-5520
Practice Address - Fax:818-353-4387
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist