Provider Demographics
NPI:1912511056
Name:MOSHASHAEI, SHERVIN (DDS, MBA)
Entity Type:Individual
Prefix:DR
First Name:SHERVIN
Middle Name:
Last Name:MOSHASHAEI
Suffix:
Gender:M
Credentials:DDS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9878 HIBERT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1142
Mailing Address - Country:US
Mailing Address - Phone:858-779-3111
Mailing Address - Fax:858-779-3112
Practice Address - Street 1:9878 HIBERT ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1142
Practice Address - Country:US
Practice Address - Phone:858-779-3111
Practice Address - Fax:858-779-3112
Is Sole Proprietor?:No
Enumeration Date:2020-09-05
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist