Provider Demographics
NPI:1528839560
Name:MEHDIAN, BRENDA DEBORAH (DDS)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:DEBORAH
Last Name:MEHDIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CHEVY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-2709
Mailing Address - Country:US
Mailing Address - Phone:310-498-4324
Mailing Address - Fax:
Practice Address - Street 1:3013 COCHRAN ST STE D
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2771
Practice Address - Country:US
Practice Address - Phone:805-522-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1095191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice