Provider Demographics
NPI:1164156311
Name:MOSHREF, SAHAR MOKHTARI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAHAR
Middle Name:MOKHTARI
Last Name:MOSHREF
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 1:1772 AUTUMN AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-5326
Mailing Address - Country:US
Mailing Address - Phone:901-690-1194
Mailing Address - Fax:
Practice Address - Street 1:3023 CENTRE OAK WAY
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-6306
Practice Address - Country:US
Practice Address - Phone:901-755-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11976261QD0000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental