Provider Demographics
NPI:1437920477
Name:MOGHADDAM, ANOOSH GOLIAN (DDS)
Entity Type:Individual
Prefix:
First Name:ANOOSH
Middle Name:GOLIAN
Last Name:MOGHADDAM
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 1:4635 ARRIBA DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4825
Mailing Address - Country:US
Mailing Address - Phone:818-535-3985
Mailing Address - Fax:
Practice Address - Street 1:7616 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-5534
Practice Address - Country:US
Practice Address - Phone:818-887-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1094181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice