Provider Demographics
NPI:1649309543
Name:MASHHOON, SHIRIN (DDS)
Entity type:Individual
Prefix:
First Name:SHIRIN
Middle Name:
Last Name:MASHHOON
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 1:6031 FOUNTAIN PARK LN
Mailing Address - Street 2:APT # 5
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3551
Mailing Address - Country:US
Mailing Address - Phone:818-888-8044
Mailing Address - Fax:
Practice Address - Street 1:11980 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 505
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5012
Practice Address - Country:US
Practice Address - Phone:310-820-6691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2014-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1505511223G0001X
CA611621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice