Provider Demographics
NPI:1881958072
Name:MOHAMMADI, MOHAMMAD MEHDI (DDS)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:MEHDI
Last Name:MOHAMMADI
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 1:1117 W MANCHESTER BLVD
Mailing Address - Street 2:UNIT O
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1500
Mailing Address - Country:US
Mailing Address - Phone:213-371-0390
Mailing Address - Fax:
Practice Address - Street 1:1117 W MANCHESTER BLVD
Practice Address - Street 2:UNIT O
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1500
Practice Address - Country:US
Practice Address - Phone:213-371-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist