Healthcare Provider Details

I. General information

NPI: 1730006883
Provider Name (Legal Business Name): DANIEL MAHJOURI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E CAMPUS LOOP S
LINCOLN NE
68583-1530
US

IV. Provider business mailing address

225 N COTNER BLVD APT 501
LINCOLN NE
68505-2376
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-1333
  • Fax:
Mailing address:
  • Phone: 858-603-7625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8232
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: