Provider Demographics
NPI:1053295485
Name:MEHRANPOUR, MAHGOL (DMD)
Entity type:Individual
Prefix:
First Name:MAHGOL
Middle Name:
Last Name:MEHRANPOUR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2290
Mailing Address - Country:US
Mailing Address - Phone:719-587-1060
Mailing Address - Fax:719-587-1525
Practice Address - Street 1:135 6TH STREET
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:CO
Practice Address - Zip Code:81125
Practice Address - Country:US
Practice Address - Phone:719-754-3584
Practice Address - Fax:719-754-2470
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO206422122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist