Provider Demographics
NPI:1801577960
Name:MEHRGANPOUR, NEEMA EMILE (DMD)
Entity type:Individual
Prefix:DR
First Name:NEEMA
Middle Name:EMILE
Last Name:MEHRGANPOUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 CREFELD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3605
Mailing Address - Country:US
Mailing Address - Phone:215-360-9756
Mailing Address - Fax:
Practice Address - Street 1:825 BETHLEHEM PIKE STE 200
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1122
Practice Address - Country:US
Practice Address - Phone:215-360-9756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0442871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice