Provider Demographics
NPI:1548438393
Name:RAMYAR, MEZGAN (DMD)
Entity type:Individual
Prefix:DR
First Name:MEZGAN
Middle Name:
Last Name:RAMYAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 E HUNTLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-1502
Mailing Address - Country:US
Mailing Address - Phone:469-831-6347
Mailing Address - Fax:972-543-9218
Practice Address - Street 1:2616 PAVILION PKWY
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-9408
Practice Address - Country:US
Practice Address - Phone:209-839-8333
Practice Address - Fax:209-839-8338
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist