Provider Demographics
NPI:1962998526
Name:MEHRAZARIN, SHEBLI (DDS, PHD)
Entity type:Individual
Prefix:
First Name:SHEBLI
Middle Name:
Last Name:MEHRAZARIN
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CLUB VIS
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3747
Mailing Address - Country:US
Mailing Address - Phone:131-099-7089
Mailing Address - Fax:
Practice Address - Street 1:22 CLUB VIS
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-3747
Practice Address - Country:US
Practice Address - Phone:131-099-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD178021223P0300X
CA617321223P0300X, 122300000X
DCDEN20002091223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist