Provider Demographics
NPI:1538759147
Name:RAJINIA, MERSEDEH (DDS)
Entity type:Individual
Prefix:
First Name:MERSEDEH
Middle Name:
Last Name:RAJINIA
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 1:7616 TOPANGA CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-5534
Mailing Address - Country:US
Mailing Address - Phone:818-518-5472
Mailing Address - Fax:
Practice Address - Street 1:7616 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-5534
Practice Address - Country:US
Practice Address - Phone:818-887-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-05-18
Deactivation Date:2021-02-27
Deactivation Code:
Reactivation Date:2021-05-18
Provider Licenses
StateLicense IDTaxonomies
CADDS1056641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty