Healthcare Provider Details

I. General information

NPI: 1528713534
Provider Name (Legal Business Name): NIMA MASHHOON, DMD, MS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 S COLLEGE DR STE 103
SANTA MARIA CA
93455-1304
US

IV. Provider business mailing address

2151 S COLLEGE DR STE 103
SANTA MARIA CA
93455-1304
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-4000
  • Fax: 805-803-1999
Mailing address:
  • Phone: 805-934-4000
  • Fax: 805-803-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NIMA MASHHOON
Title or Position: DENTIST
Credential: DMD
Phone: 805-934-4000