Provider Demographics
NPI:1558097352
Name:MOSHIRI, DIANA (DDS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MOSHIRI
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 1:1575 VERNON ODOM BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-4091
Mailing Address - Country:US
Mailing Address - Phone:330-753-7734
Mailing Address - Fax:
Practice Address - Street 1:1575 VERNON ODOM BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4091
Practice Address - Country:US
Practice Address - Phone:330-753-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI30.0269511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice