Provider Demographics
NPI:1023263548
Name:DIANATI, MEHRNOOSH (DDS)
Entity type:Individual
Prefix:DR
First Name:MEHRNOOSH
Middle Name:
Last Name:DIANATI
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 1:24585 CALVERT ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1015
Mailing Address - Country:US
Mailing Address - Phone:818-667-9244
Mailing Address - Fax:
Practice Address - Street 1:7616 WINNETKA AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2686
Practice Address - Country:US
Practice Address - Phone:818-667-9244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA553491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics