Provider Demographics
NPI:1750558755
Name:MAHMOUDI, AZARMIDOKHT M (DDS)
Entity type:Individual
Prefix:DR
First Name:AZARMIDOKHT
Middle Name:M
Last Name:MAHMOUDI
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 1:2819 CROW CANYON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1656
Mailing Address - Country:US
Mailing Address - Phone:925-997-5957
Mailing Address - Fax:925-837-3695
Practice Address - Street 1:2819 CROW CANYON RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1656
Practice Address - Country:US
Practice Address - Phone:925-837-2225
Practice Address - Fax:925-837-3695
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist