Provider Demographics
NPI:1952641755
Name:MEHRAN JAVAHERIAN DDS INC
Entity Type:Organization
Organization Name:MEHRAN JAVAHERIAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVAHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-633-9300
Mailing Address - Street 1:10721 ATLANTIC AVE
Mailing Address - Street 2:J
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2373
Mailing Address - Country:US
Mailing Address - Phone:562-633-9300
Mailing Address - Fax:562-633-9339
Practice Address - Street 1:10721 ATLANTIC AVE
Practice Address - Street 2:J
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2373
Practice Address - Country:US
Practice Address - Phone:562-633-9300
Practice Address - Fax:562-633-9339
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEHRAN JAVAHERIAN DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty