Provider Demographics
NPI:1912113549
Name:MIRHADI, NOOSHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NOOSHAN
Middle Name:
Last Name:MIRHADI
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 1:2914 DOMINGO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2454
Mailing Address - Country:US
Mailing Address - Phone:510-849-1006
Mailing Address - Fax:510-849-1185
Practice Address - Street 1:2914 DOMINGO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2454
Practice Address - Country:US
Practice Address - Phone:510-849-1006
Practice Address - Fax:510-849-1185
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice