Provider Demographics
NPI:1295949915
Name:MOSTAFAEIPOUR, MEHRDAD (DDS)
Entity type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:MOSTAFAEIPOUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:MOST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1701 DOUBLE ARCH CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8485
Mailing Address - Country:US
Mailing Address - Phone:702-338-8550
Mailing Address - Fax:702-363-8951
Practice Address - Street 1:6392 SPRING MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8806
Practice Address - Country:US
Practice Address - Phone:702-871-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV37201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice