Provider Demographics
NPI:1902026388
Name:TEHRANI RAD, MOSTAFA (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:MOSTAFA
Middle Name:
Last Name:TEHRANI RAD
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22949 VENTURA BLVD
Mailing Address - Street 2:SUITE #C
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-225-8800
Mailing Address - Fax:818-225-8826
Practice Address - Street 1:22949 VENTURA BLVD #C
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-225-8800
Practice Address - Fax:818-225-8826
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry