Provider Demographics
NPI:1194102863
Name:SORAYA K. MAHRAN, DDS, INC
Entity type:Organization
Organization Name:SORAYA K. MAHRAN, DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-466-4875
Mailing Address - Street 1:30001 CROWN VALLEY PKWY STE G
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1723
Mailing Address - Country:US
Mailing Address - Phone:310-466-4875
Mailing Address - Fax:
Practice Address - Street 1:30001 CROWN VALLEY PKWY STE G
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1723
Practice Address - Country:US
Practice Address - Phone:310-466-4875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA600961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty