MEDICARE: MAHMOOD D.D.S., DENTAL CORP

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1831741669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHMOOD D.D.S., DENTAL CORP

Provider Business Mailing Address
First Line	:	6475 ALVARADO RD STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5013
Country	:	US
Telephone Number	:	619-287-0990
Fax Number	:

Provider Business Practice Location Address
First Line	:	6475 ALVARADO RD STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5013
Country	:	US
Telephone Number	:	619-287-0990
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/DENTIST
Name	:	DR. TRUSKA MAHMOOD
Credential	:	DDS
Telephone Number	:	619-287-1990

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	07/11/2019

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