Provider Demographics
NPI:1003394453
Name:MOOSAVI, VIQAR H (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIQAR
Middle Name:H
Last Name:MOOSAVI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TAMMY LN
Mailing Address - Street 2:
Mailing Address - City:MICKLETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08056-1024
Mailing Address - Country:US
Mailing Address - Phone:609-332-8609
Mailing Address - Fax:
Practice Address - Street 1:1636 ROUTE 38 STE 21
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2987
Practice Address - Country:US
Practice Address - Phone:609-914-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027228001223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice