Provider Demographics
NPI:1225762735
Name:MOFRAD, GHAZAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GHAZAL
Middle Name:
Last Name:MOFRAD
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 1:9528 SCENIC SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7218
Mailing Address - Country:US
Mailing Address - Phone:304-804-4494
Mailing Address - Fax:
Practice Address - Street 1:2250 S RANCHO DR STE 205
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4456
Practice Address - Country:US
Practice Address - Phone:702-779-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist