Provider Demographics
NPI:1396800363
Name:MAHBOUB, MAHYAR (DDS)
Entity type:Individual
Prefix:DR
First Name:MAHYAR
Middle Name:
Last Name:MAHBOUB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 IRVINE CENTER DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3305
Mailing Address - Country:US
Mailing Address - Phone:949-653-6318
Mailing Address - Fax:949-653-6374
Practice Address - Street 1:4902 IRVINE CENTER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3305
Practice Address - Country:US
Practice Address - Phone:949-653-6318
Practice Address - Fax:949-653-6374
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice