Provider Demographics
NPI:1982012258
Name:MASHREGHI DMD DENTAL CORPORATION
Entity Type:Organization
Organization Name:MASHREGHI DMD DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHREGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:323-906-9066
Mailing Address - Street 1:5754 WILLOWCREST AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2122
Mailing Address - Country:US
Mailing Address - Phone:323-906-9066
Mailing Address - Fax:
Practice Address - Street 1:5754 WILLOWCREST AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2122
Practice Address - Country:US
Practice Address - Phone:323-906-9066
Practice Address - Fax:323-666-8036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty