Provider Demographics
NPI:1952430365
Name:MAHMOODVANDI, MEHDI (DDS)
Entity Type:Individual
Prefix:
First Name:MEHDI
Middle Name:
Last Name:MAHMOODVANDI
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 1:1795 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2093
Mailing Address - Country:US
Mailing Address - Phone:408-293-0304
Mailing Address - Fax:408-293-0307
Practice Address - Street 1:1795 PARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2093
Practice Address - Country:US
Practice Address - Phone:408-293-0304
Practice Address - Fax:408-293-0307
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice