Provider Demographics
NPI:1598842197
Name:KHAZIAN, MEHRAN (DDS)
Entity type:Individual
Prefix:
First Name:MEHRAN
Middle Name:
Last Name:KHAZIAN
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 1:650 DOUGLAS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6949
Mailing Address - Country:US
Mailing Address - Phone:760-721-1095
Mailing Address - Fax:760-721-1806
Practice Address - Street 1:650 DOUGLAS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6949
Practice Address - Country:US
Practice Address - Phone:760-721-1095
Practice Address - Fax:760-721-1806
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist