Provider Demographics
NPI:1346766979
Name:MOSTAJABIAN, SAMAN (DDS)
Entity Type:Individual
Prefix:
First Name:SAMAN
Middle Name:
Last Name:MOSTAJABIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAMAN
Other - Middle Name:
Other - Last Name:MOSTAJABIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:25878 POLLARD RD APT 2124
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-5153
Mailing Address - Country:US
Mailing Address - Phone:949-566-5042
Mailing Address - Fax:
Practice Address - Street 1:3281 BEL AIR MALL STE G18A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3207
Practice Address - Country:US
Practice Address - Phone:251-301-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist