Provider Demographics
NPI:1093984304
Name:MOINI, MAHKAMEH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAHKAMEH
Middle Name:
Last Name:MOINI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MAHKAMEH
Other - Middle Name:MOINI
Other - Last Name:MABRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:5522 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3468
Mailing Address - Country:US
Mailing Address - Phone:954-968-4466
Mailing Address - Fax:
Practice Address - Street 1:5522 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33073-3468
Practice Address - Country:US
Practice Address - Phone:954-968-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist