Provider Demographics
NPI:1316241052
Name:MEHR, MAHI SOPHIA (DDS & MSC)
Entity type:Individual
Prefix:DR
First Name:MAHI
Middle Name:SOPHIA
Last Name:MEHR
Suffix:
Gender:F
Credentials:DDS & MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 N HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7694
Mailing Address - Country:US
Mailing Address - Phone:312-373-1117
Mailing Address - Fax:
Practice Address - Street 1:2620 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7694
Practice Address - Country:US
Practice Address - Phone:312-373-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190295841223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology