Provider Demographics
NPI:1871377986
Name:MEHRAZAR, PASHA (DDS)
Entity type:Individual
Prefix:DR
First Name:PASHA
Middle Name:
Last Name:MEHRAZAR
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 1:17020 BURBANK BLVD APT 205
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1802
Mailing Address - Country:US
Mailing Address - Phone:818-699-4567
Mailing Address - Fax:
Practice Address - Street 1:813 FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:S PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2605
Practice Address - Country:US
Practice Address - Phone:626-593-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1091391223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice