Provider Demographics
NPI:1699978999
Name:MAHMOOD, MOHSIN (DDS)
Entity type:Individual
Prefix:DR
First Name:MOHSIN
Middle Name:
Last Name:MAHMOOD
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 1:24902 MOULTON PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-6403
Mailing Address - Country:US
Mailing Address - Phone:949-619-4162
Mailing Address - Fax:949-215-1126
Practice Address - Street 1:24102 EL TORO RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-3123
Practice Address - Country:US
Practice Address - Phone:949-830-6510
Practice Address - Fax:949-472-4073
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice