| Mahyar Mahboub Dds, A Professional Corporation | |
|
4902 Irvine Center Dr Suite 202 Irvine CA 92604-3305 | |
| (949) 653-6318 | |
| (949) 653-6374 |
| Full Name | Mahyar Mahboub Dds, A Professional Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4902 Irvine Center Dr, Irvine, California |
| Authorized Official Name and Position | Mahyar Mahboub (PRESIDENT) |
| Authorized Official Contact | 9496536318 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mahyar Mahboub Dds, A Professional Corporation 4902 Irvine Center Dr Suite 202 Irvine CA 92604-3305 Ph: (949) 653-6318 | Mahyar Mahboub Dds, A Professional Corporation 4902 Irvine Center Dr Suite 202 Irvine CA 92604-3305 Ph: (949) 653-6318 |
| NPI Number | 1306056544 |
|---|---|
| Provider Enumeration Date | 05/23/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306056544 | NPI | - | NPPES |
| G-92967-01 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 45586 (California) | Primary |
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