Provider Demographics
NPI:1487020772
Name:ANVARI TEHRANI, MOJDEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOJDEH
Middle Name:
Last Name:ANVARI TEHRANI
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 1:8377 E VIA DE VENTURA APT G216
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3146
Mailing Address - Country:US
Mailing Address - Phone:602-703-5915
Mailing Address - Fax:
Practice Address - Street 1:8377 E VIA DE VENTURA APT G216
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3146
Practice Address - Country:US
Practice Address - Phone:602-703-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009357122300000X
CA65008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist