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General NPI Number Information
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NPI Number | 1922651389
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Entity Type | Individual
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Provider Name | NIMA MASHHOON DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 2151 S COLLEGE DR STE 103
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City | SANTA MARIA
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State | CA
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Zip | 93455-1304
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Country | US
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Telephone | 805-934-4000
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Fax | 805-803-1999
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Provider Business Mailing Address
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Address Line | 2151 S COLLEGE DR STE 103
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City | SANTA MARIA
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State | CA
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Zip | 93455-1304
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Country | US
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Telephone | 805-934-4000
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Fax | 805-803-1999
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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 | 103858
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License Number State | CA
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