Provider Demographics
NPI:1780604165
Name:MAZAHERI, MOHAMMAD N/A (MDD, DDS, MSC)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:N/A
Last Name:MAZAHERI
Suffix:
Gender:M
Credentials:MDD, DDS, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N LIME ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2748
Mailing Address - Country:US
Mailing Address - Phone:717-396-7409
Mailing Address - Fax:717-396-7409
Practice Address - Street 1:223 N LIME ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2748
Practice Address - Country:US
Practice Address - Phone:717-396-7409
Practice Address - Fax:717-396-7409
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS013902L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics