Basic Information
| Provider Information | |||||||||
| NPI: | 1568138303 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLSHAN | ||||||||
| FirstName: | MAHFAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22719 BRANDYWINE DR | ||||||||
| Address2: | |||||||||
| City: | CALABASAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913025736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083008256 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1381 W CHANNEL ISLANDS BLVD | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930334203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052531796 | ||||||||
| FaxNumber: | 8052531871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2021 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 106655 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.