MEDICARE: DR. AMIR HOSSEIN MEHRABI DDS., MSD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	7022	TN
2	1223E0200X	Endodontics	3100	AR

General Provider Information

NPI Number	:	1760492953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIR HOSSEIN MEHRABI DDS., MSD.

Provider Business Mailing Address
First Line	:	1225 BRECKENRIDGE DR
Second Line	:	SUITE 203
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-1558
Country	:	US
Telephone Number	:	501-227-7949
Fax Number	:	501-227-7763

Provider Business Practice Location Address
First Line	:	1225 BRECKENRIDGE DR
Second Line	:	SUITE 203
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-1558
Country	:	US
Telephone Number	:	501-227-7949
Fax Number	:	501-227-7763

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/09/2012

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