Provider Demographics
NPI:1083295943
Name:MOJDEH FARAZ DDS INC
Entity Type:Organization
Organization Name:MOJDEH FARAZ DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOJDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-315-5216
Mailing Address - Street 1:230 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3136
Mailing Address - Country:US
Mailing Address - Phone:831-722-9202
Mailing Address - Fax:
Practice Address - Street 1:230 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3136
Practice Address - Country:US
Practice Address - Phone:831-722-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty