Healthcare Provider Details

I. General information

NPI: 1760492953
Provider Name (Legal Business Name): AMIR HOSSEIN MEHRABI DDS., MSD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 BRECKENRIDGE DR SUITE 203
LITTLE ROCK AR
72205-1558
US

IV. Provider business mailing address

1225 BRECKENRIDGE DR SUITE 203
LITTLE ROCK AR
72205-1558
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-7949
  • Fax: 501-227-7763
Mailing address:
  • Phone: 501-227-7949
  • Fax: 501-227-7763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7022
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3100
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: