Provider Demographics
NPI:1326221615
Name:FIROUZBAKHT, MEHRZAD (DDS)
Entity type:Individual
Prefix:
First Name:MEHRZAD
Middle Name:
Last Name:FIROUZBAKHT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1958
Mailing Address - Country:US
Mailing Address - Phone:818-908-9199
Mailing Address - Fax:818-909-7129
Practice Address - Street 1:17827 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1616
Practice Address - Country:US
Practice Address - Phone:818-282-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice