Provider Demographics
NPI:1295931327
Name:MASHTOUB, FERRAS CHAWKI (DDS)
Entity type:Individual
Prefix:DR
First Name:FERRAS
Middle Name:CHAWKI
Last Name:MASHTOUB
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 1:19231 VICTORY BLVD STE 352
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6352
Mailing Address - Country:US
Mailing Address - Phone:818-654-6136
Mailing Address - Fax:818-654-6228
Practice Address - Street 1:19231 VICTORY BLVD STE 352
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6352
Practice Address - Country:US
Practice Address - Phone:818-654-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice