Provider Demographics
NPI:1043438252
Name:MOLLAMOHAMMAD, AREZOUKHANOM DADGAR (DDS)
Entity Type:Individual
Prefix:
First Name:AREZOUKHANOM
Middle Name:DADGAR
Last Name:MOLLAMOHAMMAD
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 1:11822 FLORAL DR
Mailing Address - Street 2:SUIT D
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-2900
Mailing Address - Country:US
Mailing Address - Phone:562-692-7870
Mailing Address - Fax:562-692-8483
Practice Address - Street 1:11822 FLORAL DR
Practice Address - Street 2:SUIT D
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-2900
Practice Address - Country:US
Practice Address - Phone:562-692-7870
Practice Address - Fax:562-692-8483
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47250122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist