Provider Demographics
NPI:1063855401
Name:MOHAJER, MARJAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARJAN
Middle Name:
Last Name:MOHAJER
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 1:91 HAMMOND LN
Mailing Address - Street 2:GENTLE TOUCH FAMILY DENTISTRY
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2000
Mailing Address - Country:US
Mailing Address - Phone:518-324-5555
Mailing Address - Fax:
Practice Address - Street 1:91 HAMMOND LN
Practice Address - Street 2:GENTLE TOUCH FAMILY DENTISTRY
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2000
Practice Address - Country:US
Practice Address - Phone:518-324-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist