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General NPI Number Information
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NPI Number | 1114308442
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Entity Type | Individual
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Provider Name | MAHYAR LOTFI D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 1455 STATE ROAD 436 STE 101
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City | CASSELBERRY
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State | FL
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Zip | 32707-6514
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Country | US
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Telephone | 407-708-9228
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Fax |
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Provider Business Mailing Address
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Address Line | 941 HYLAND DR
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City | SANTA ROSA
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State | CA
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Zip | 95404-2229
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Country | US
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Telephone | 858-342-4420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS100138
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 21268
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License Number State | FL
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