Provider Demographics
NPI:1104552348
Name:SHERVIN MOSHASHAEI DDS MBA INC
Entity type:Organization
Organization Name:SHERVIN MOSHASHAEI DDS MBA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHASHAEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MBA
Authorized Official - Phone:858-779-3111
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:310-993-8702
Mailing Address - Fax:
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:310-993-8702
Practice Address - Fax:858-779-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty