Provider Demographics
NPI:1063072395
Name:RAZAGHY, MEHRDAD (DDS)
Entity type:Individual
Prefix:
First Name:MEHRDAD
Middle Name:
Last Name:RAZAGHY
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 1:9100 WILSHIRE BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3473
Mailing Address - Country:US
Mailing Address - Phone:310-923-9494
Mailing Address - Fax:
Practice Address - Street 1:9100 WILSHIRE BLVD STE 420
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3473
Practice Address - Country:US
Practice Address - Phone:310-923-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1038001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103800OtherDENTAL BOARD OF CALIFORNIA