Provider Demographics
NPI:1649790148
Name:IRANPOUR, MAHSA (DMD)
Entity type:Individual
Prefix:DR
First Name:MAHSA
Middle Name:
Last Name:IRANPOUR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 GATEWAY UNIT 2349
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-5825
Mailing Address - Country:US
Mailing Address - Phone:424-208-4052
Mailing Address - Fax:
Practice Address - Street 1:1079 MAXEY DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2868
Practice Address - Country:US
Practice Address - Phone:424-208-4052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101460122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist