Provider Demographics
NPI:1184831091
Name:MOSHARAF, MONI M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONI
Middle Name:M
Last Name:MOSHARAF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27068 LA PAZ RD # 440
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3041
Mailing Address - Country:US
Mailing Address - Phone:949-702-2001
Mailing Address - Fax:714-971-6224
Practice Address - Street 1:2 JOURNEY STE 207
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3373
Practice Address - Country:US
Practice Address - Phone:949-702-2001
Practice Address - Fax:949-643-2226
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist