Provider Demographics
NPI:1972850915
Name:MEHDIPOUR, MAHSHID (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAHSHID
Middle Name:
Last Name:MEHDIPOUR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 E GREENWAY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4508
Mailing Address - Country:US
Mailing Address - Phone:623-215-9699
Mailing Address - Fax:
Practice Address - Street 1:3229 E GREENWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4508
Practice Address - Country:US
Practice Address - Phone:623-215-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD084841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty