Provider Demographics
NPI:1033934229
Name:SEAN S MOHTASHAMI DDS INC
Entity type:Organization
Organization Name:SEAN S MOHTASHAMI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:I
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-242-2075
Mailing Address - Street 1:3918 LONG BEACH BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2666
Mailing Address - Country:US
Mailing Address - Phone:562-242-2075
Mailing Address - Fax:
Practice Address - Street 1:3918 LONG BEACH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2685
Practice Address - Country:US
Practice Address - Phone:562-242-2075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty