Provider Demographics
NPI:1013494202
Name:AL MASHTA, TAHANI (DDS)
Entity Type:Individual
Prefix:
First Name:TAHANI
Middle Name:
Last Name:AL MASHTA
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 1:1901 HALFORD AVE APT 158
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-7411
Mailing Address - Country:US
Mailing Address - Phone:415-999-8330
Mailing Address - Fax:
Practice Address - Street 1:38056 MARTHA AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3809
Practice Address - Country:US
Practice Address - Phone:510-505-9409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist