Provider Demographics
NPI:1225811722
Name:MOFRAD, SARA MOHASEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:MOHASEL
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 1:7370 CARSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2360
Mailing Address - Country:US
Mailing Address - Phone:056-224-7978
Mailing Address - Fax:
Practice Address - Street 1:7370 CARSON BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2360
Practice Address - Country:US
Practice Address - Phone:562-247-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS109074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist