Provider Demographics
NPI:1013149624
Name:MEHRIAN, ANJELA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANJELA
Middle Name:
Last Name:MEHRIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E 40TH ST
Mailing Address - Street 2:STE 302
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1723
Mailing Address - Country:US
Mailing Address - Phone:917-362-5090
Mailing Address - Fax:212-983-4657
Practice Address - Street 1:124 E 40TH ST
Practice Address - Street 2:STE 302
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1723
Practice Address - Country:US
Practice Address - Phone:917-362-5090
Practice Address - Fax:212-983-4657
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0553151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice