Provider Demographics
NPI:1750562385
Name:MASHREGHI, ALIREZA (DDS)
Entity type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:MASHREGHI
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 1:5754 WILLOWCREST AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2122
Mailing Address - Country:US
Mailing Address - Phone:323-906-9066
Mailing Address - Fax:323-666-8036
Practice Address - Street 1:5754 WILLOWCREST AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2122
Practice Address - Country:US
Practice Address - Phone:323-906-9066
Practice Address - Fax:323-666-8036
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56533122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56533Medicaid