Individual
MAHSHID AKHAVAN FARAHANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5471 DR MARTIN LUTHER KING DR, SAINT LOUIS, MO 63112-4265
(314) 633-6363
Mailing address
322 S MIRALESTE DR, SAN PEDRO, CA 90732-3018
(816) 665-3271
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2021013177
MO
1223G0001X
General Practice Dentistry
104696
CA
1223G0001X
General Practice Dentistry
2021013177
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2019
Last updated
06/29/2021
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