MEDICARE: NAVID MEHRANPOUR D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	63000	CA

General Provider Information

NPI Number	:	1578990099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAVID MEHRANPOUR D.D.S.

Provider Business Mailing Address
First Line	:	1545 N TEXAS ST STE 311
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-5623
Country	:	US
Telephone Number	:	707-422-2410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1545 N TEXAS ST STE 311
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-5623
Country	:	US
Telephone Number	:	707-422-2410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2013
Last Update Date	:	05/10/2018

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