Provider Demographics
NPI:1548374515
Name:MAHMOUDZADEH, PARVANEH (DDS)
Entity type:Individual
Prefix:
First Name:PARVANEH
Middle Name:
Last Name:MAHMOUDZADEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:
Other - Last Name:MAHMOUDZADEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10433 TAM O SHANTER RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-8306
Mailing Address - Country:US
Mailing Address - Phone:850-477-5537
Mailing Address - Fax:
Practice Address - Street 1:311 EAST NINE MILE ROAD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514
Practice Address - Country:US
Practice Address - Phone:850-477-6934
Practice Address - Fax:850-476-0605
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14508122300000X
ALLN05387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist