Provider Demographics
NPI:1922651389
Name:MASHHOON, NIMA (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:MASHHOON
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 1:2151 S COLLEGE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1304
Mailing Address - Country:US
Mailing Address - Phone:805-934-4000
Mailing Address - Fax:805-803-1999
Practice Address - Street 1:2151 S COLLEGE DR STE 103
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1304
Practice Address - Country:US
Practice Address - Phone:805-934-4000
Practice Address - Fax:805-803-1999
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist