Provider Demographics
NPI:1205177185
Name:MEHRKHODAVANDI, NEEMA BEHZAD (DDS)
Entity type:Individual
Prefix:
First Name:NEEMA
Middle Name:BEHZAD
Last Name:MEHRKHODAVANDI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SPRUCE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2666
Mailing Address - Country:US
Mailing Address - Phone:415-221-1788
Mailing Address - Fax:
Practice Address - Street 1:500 SPRUCE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2666
Practice Address - Country:US
Practice Address - Phone:415-221-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-02
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856090122300000X
CA62035122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist