Provider Demographics
NPI:1194959379
Name:AHANGAR, MAHNAZ BRENDA (RDHAP)
Entity type:Individual
Prefix:MISS
First Name:MAHNAZ
Middle Name:BRENDA
Last Name:AHANGAR
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 S BUNDY DR
Mailing Address - Street 2:#208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5247
Mailing Address - Country:US
Mailing Address - Phone:310-795-0179
Mailing Address - Fax:
Practice Address - Street 1:809 S BUNDY DR
Practice Address - Street 2:#208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5247
Practice Address - Country:US
Practice Address - Phone:310-795-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist