Provider Demographics
NPI:1457561722
Name:EBRAHIMI, MEHRYAR (DDS)
Entity type:Individual
Prefix:DR
First Name:MEHRYAR
Middle Name:
Last Name:EBRAHIMI
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 1:9454 WILSHIRE BLVD STE 311
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2904
Mailing Address - Country:US
Mailing Address - Phone:310-246-9321
Mailing Address - Fax:
Practice Address - Street 1:9454 WILSHIRE BLVD STE 311
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2904
Practice Address - Country:US
Practice Address - Phone:310-246-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice