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General NPI Number Information
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NPI Number | 1497765713
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Entity Type | Individual
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Provider Name | DANIEL GHORBANI MASHOOF D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 12821 MAIN ST STE 150
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City | HESPERIA
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State | CA
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Zip | 92345-9130
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Country | US
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Telephone | 760-947-9853
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Fax | 760-956-7813
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Provider Business Mailing Address
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Address Line | 12821 MAIN ST STE 150
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City | HESPERIA
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State | CA
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Zip | 92345-9130
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Country | US
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Telephone | 425-213-6606
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Fax | 425-643-3733
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DE00009770
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License Number State | WA
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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 | DDS60273
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License Number State | CA
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