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Provider Information for 1578990099



NAVID MEHRANPOUR D.D.S.

Gender: MALE

Individual NPI: 1578990099

Calendar Last Updated: 2018-05-10

Details

Name Value
NPI 1578990099
Enumeration Date 2013-09-29
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 1545 N TEXAS ST STE 311
FAIRFIELD, CA 94533-5623
United States

Phone: 707-422-2410 | Fax:
View Map External Link
Primary Practice Address 1545 N TEXAS ST STE 311
FAIRFIELD, CA 94533-5623
United States

Phone: 707-422-2410 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist CA 63000